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momdogz
Epidem. question: vonWillebrands

8/9/07:

23 yo G1P1 with vonWillebrand's,  5 Fr Groshong DL placed on 8/9/07 for Humate P infusions after infusions of Factor 8 brought her VWB antigen to around or slightly above 100 and her factor 8 assay to 140 with range 61-192.

Uncomplicated course, pt. delivered baby, PICC line stayed in place with no problems until removal.

9/24 PICC line removed (?because treatment completed?  no record), had sudden onset of shaking/chills, fever of 101.2F.  Blood cultures negative, WBC had been normal from insertion time through the episode that caused her to present in the ED.

Comments? Increased risk of thrombi in these patients with the Factor 8 infusions?  and then septic thrombi/emboli?

Anyone else have experience with this? 

Mari

Chief Complaint: FEVER and CHILLS.Onset was abrupt (p PICC LINE REMOVAL).  Pain level now: 0/10.  The patient has had fever of 101.2 F orally with chills.
lynncrni
How long did this episode of
How long did this episode of fever and chills last? Was the catheter flushed immediately before it was removed? My guess would be that biofilm from the external and possibly the internal catheter lumen broke off when the catheter was flushed and/or removed. This caused a shower of bacteria that lead to the fever and chills, but the patient's immune system was about to overcome this bacteria if it was a short-lived problem. Blood culture being negative only means that the sample you obtained did not capture any free-floating (planktonic) organisms, but it does not mean that none was present in her bloodstream. This is not an unusual occurrence during flushing of long-term catheters. Lynn

Lynn Hadaway, M.Ed., NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

momdogz
Thanks, Lynn.  Her

Thanks, Lynn. 

Her symptoms were very short-lived (an hour or two max).  Her WBC was normal when she went to the ED (immediately after the event - appears that her PICC was removed at home by Visiting Nurse Association.

I read your earlier posting about the bacterial shower; any additional resources you could refer to me?  I'd like to provide our department, as well as Infectious Disease and Infection Control departments, with more information.

Best,

 

Mari 

 

 

 

Mari Cordes, BS RN 

Nurse Educator IV Therapy
Fletcher Allen Health Care

Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center

lynncrni
This concept of bacterial

This concept of bacterial showers has been discussed in some of Marcia Ryder's work. Try looking for these:

1.    Ryder M. Catheter-related infections: It's all about biofilm. Topics in Advanced Practice Nursing eJournal. 2005;5(3).
2.    Ryder M. The role of biofilm in vascular catheter-related infections. New Developments in Vascular Disease [Fall 2001:15-25. Available at: http://www.medpub.com/cme.htm,. Accessed February 5, 2002, 2002.
 

Lynn Hadaway, M.Ed., NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

momdogz
I'm very grateful for her
I'm very grateful for her and her cohorts' work, and glad to have met her at AVA in Phoenix.

The New Developments in Vascular Disease looks like a good journal; I'm going to see if I can contact Permissions to see if I can use some of their material for teaching purposes.

Thanks again, Lynn!

Mari Cordes, BS RN 
Nurse Educator IV Therapy
Fletcher Allen Health Care

Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center

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