Probably, if the line is the problem there will be improvement
with removal. Lynn
At 10:12 AM -0600 8/14/06, Rakay Dance wrote:
So if the patient shows NO improvement for 4 days after line removal and then they diagnose viral pneumonia does that clear the line from being the problem?? RaKay
From: Lynn Hadaway [mailto:[EMAIL PROTECTED]
Sent: Monday, August 14, 2006 7:44 AM
To: Heather Nichols; [EMAIL PROTECTED]; [EMAIL PROTECTED]; Rakay Dance
Subject: Re: Central Line Infection
I can give you those terms and explanation. Biofilm is organisms residing in a slimy matrix. Organism cells make up about 15% or so and the rest is slime. A blood culture will only be positive if you have collected a sample that contains planktonic organisms, those that have broken off and are free floating. The remaining sessile (adherent) organisms are not collected. There are several ways that biofilm detaches - single cells, clumps of cells, rolling motility. So cells are detaching and producing the signs and symptoms yet the actual blood culture may be negative. When you culture only the external side of the catheter tip, you are not even attempting to reach what is inside the catheter lumen. Older catheters have much more biofilm on the internal lumen than on the external side. Lynn
At 8:13 AM -0400 8/14/06, Heather Nichols wrote:
Content-Type: text/html;
charset=us-ascii
Content-Transfer-Encoding: 7bit
Content-Description: HTML
I have been rounding a lot recently with Infectious Disease doc's. They have shown me beyond a shadow of a doubt, more then once, that you can have an infected line and all negative cultures (blood and tip). It is the power of deduction. A patient comes in sick as can be. Fever, chills, increased abnormal wht count, and has a vascular access device. They do blood cultures- all negative. They remove the device and culture the tip- comes back negative, but the patient show immediate signs of improvement after the device is removed. I asked why, and the attending told me that the line can be infected and not show any positive cultures. Something about biofilm and colonization. I'm learning. I'll get back to you when I can spout off long important terms and words.......
Heather Nichols RN BSN CRNI
Infusion Services
University of Louisville Trauma Institute
530 S. Jackson St.
Lou. Ky. 40202
(502)562-3530
>>> "Nancy Moureau" <[EMAIL PROTECTED]> 8/10/2006 3:08 PM >>>
Sorry Rakay, Visible Bacteria in a CBC? I assume the white count was up. If all blood cultures are negative both peripheral and line draws then you may be talking about a contaminant. TPN is notorious for growing bacteria and certainly is a risk factor for infection. The patient may have a virus, esp with the glandular swelling.
Nancy Moureau, BSN, CRNI
PICC Excellence, Inc
[EMAIL PROTECTED]
1-888-714-1951
---------- Original Message ----------------------------------
From: "Rakay Dance" <[EMAIL PROTECTED]>
Date: Thu, 10 Aug 2006 12:41:33 -0600
>Hi, I am looking for some expert opinions. We had a PICC line in place
>8 weeks. Pt is receiving TPN for extreme hyperemesis gravadarium. On
>weekly labs Monday the lab noted visiable bacteria in the CBC. On
>Tuesday PICC was pulled and repeat CBC and Blood cultures PIV were
>drawn.&nb sp; No bacteria noted on this sample. Blood Cultures remain
>negative after 48 hours. Is this likely a line infection or something
>else. The tip was not cultured. Pt is now hospitalized and continues
>to spike fevers and is on IVAB. Infection remains unknown. Pt's WBC
>was 2.7 when admitted to hospital. Pt has very large swollen glands in
>neck, headache and stiff neck. No spinal has been done. I would love
>your opinion's-line infected or no?? RaKay
>
>
>
-----------------------------------------------------
Confidentiality Disclaimer
This message, including any attachments, is confidential, intended only for the named recipient(s) and may contain information that is privileged or exempt from disclosure under applicable law, including PHI (Protected Health Information) covered under the Health Insurance Portability and Accountability Act (HIPAA) of 1996. If you are not the intended recipient(s), you are notified that the dissemination, distribution, or copying of this message is strictly prohibited. If you receive this message in error, or are not the named recipient(s), please notify the sender or contact the University of Louisville Health Care I.S. helpdesk at 502.562.3637 to report an inadvertently received message.
-----------------------------------------------------
Attachment converted: G4 Laptop:Heather Nichols 110.vcf (TEXT/ttxt) (0026A5D0)
--
Lynn Hadaway, M.Ed., RNC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
http://www.hadawayassociates.com
office 770-358-7861
--
Lynn Hadaway, M.Ed., RNC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
http://www.hadawayassociates.com
office 770-358-7861
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
http://www.hadawayassociates.com
office 770-358-7861
