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Jerrbear
Implanted port salvage
We have a patient whose port may be infected and at the age of 43 most of her accessible veins are just a memory.  We are looking at the possibility of trying to salvage it using a combination of antibiotic infusions and antibiotic locks.  What I am wondering is whether the likelihood of success would improve if we treated it with TPA first.  Does TPA dissolve biofilm?
lynncrni
I am not aware of any

I am not aware of any publications that advocate for using tPA before an antibiotic lock. tPA has not affect on biofilm.  

Lynn Hadaway, M.Ed., RN, BC, CRNI

www.hadawayassociates.com

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

Jerrbear
That's what I was afraid

That's what I was afraid of.  I found an article that states "In addition, attempts should be made to disrupt the integrity of the biofilm with urokinase or ethanol before administration of the antibiotic" (Simon, Bode & Beutel, 2006, p. 608).  The article cites three other sources advocating the use of urokinase, but there is no mention of tPA.  It could take some digging to discover whether the recommendation is evidence-based, or educated guessing.

Ref:  Clin Microbiol Infect 2006; 12: 606-620.

Jerry Bartholomew RN, BSN, CRNI

VA Medical Center, Spokane, WA

Jerry Bartholomew RN, MSN, CRNI

VA Medical Center, Spokane, WA

Karen Day
Karen Day's picture
talk with your Genentech

talk with your Genentech Rep, I may be wrong but I believe the IFU on cathflo state not to use on lines with suspected infections.

Karen

 

lynncrni
There will always be biofilm

There will always be biofilm on virtually all catheters of all types. Just because there are no signs or symptoms of infection does not mean that there is no biofilm. The fibrin may attach first to the catheter with the biofilm growing on top of the fibrin. Or the fibrin may be attached to the biofilm. tPA is only going to work on the fibrin, meaning that the biofilm can become loosened. Cells or clumps can detach and float freely, known as planktonic cells in the literature. If this gets flushed into the patient, it could overwhelm the immune system and produce a BSI. So after the declotting procedure, my understanding from Genentech is that they recommend aspiration to pull this out of the catheter if possible before it is flushed in. Either way you could flush biofilm into the bloodstream, but this happens anyway with each flush. Have you ever flushed a catheter where the patient immediately developed fever and chills? This is the clumps, clusters or cells from the biofilm breaking off and floating into the bloodstream. So I don't think you can eliminate use of tPA from lines that you suspect infection or it would never be used because they all could fall into this category.  

 

Lynn Hadaway, M.Ed., RN, BC, CRNI

www.hadawayassociates.com

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

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