An update for those of you who responded to my question about the patient
who had an infected pacemaker pocket (pacer removed and placed at other side
of the chest) and an osteomyleitis in the sternum.
I spoke to the ID Dr yesterday, and he said they decided (this was at a
sister facility, not mine) to go with a Midline for at least 2 weeks, switch
to a new midline on the other arm for 2 weeks and if the site is holding up
well to leave it there to the end of therapy. He said if he can get only 4
weeks of Rocehpin IV he'll 'settle' for that and will finish out with orals.
I cautioned him to tell the nurses to be very vigilant re pt c/o pain near
the catheter tip and not to wait for other symptoms before pulling the line.
The patient will be going home with this and I'd be surprised if that
cautionary statement makes it all the way to the home infusion provider. It
is an unfortunate situation.
Alma Kooistra RN, CRNI
----Original Message Follows----
From: "Alma Kooistra" <[EMAIL PROTECTED]>
To: [EMAIL PROTECTED], [EMAIL PROTECTED]
Subject: Pacer wires PICCs and Rocephin
Date: Fri, 08 Sep 2006 05:56:15 -0500
I addressed the topic of using the opposite limb for the PICC, but since
this patient is pacer dependent and the device is newly placed, the Dr was
concerned about the risk of thrombus formation binding the electrode wires
and the PICC with potential dislodgement of electrode when it was time for
removal of device. Removing it under fluoro may be an option.
I mentioned the option of placing it under fluoro and keeping the tip in the
upper third of the svc (central, but potentially mostly away from the pacer
wires). What do you think of that?
Rocephin looks pretty good from a pH standpoint (I'm at home now and don't
have my pH info here) for midline/peripheral dosing, but it is a definitely
an irritant so we don't give it midline. That's not an option. Neither is
6 weeks of IM dosing.
Alma Kooistra RN, CRNI
