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Amy
Patterned Fevers with Multiple Central Line Placements
We currently have a patient on our services with severe Crohn's disease.  He is currently on cycled TPN at HS.  I also infuse Tysabri monthly.  Last Tysabri infusion was July 17.  patient has had a total of 3 central lines in the last 6 months..2 PICC's and currently tunneled catheter.  First PICC was removed after developing fever of 103 and culture grew candidas.  Second PICC was removed after the same development of fever but culture was negative.  Pt has currently been running around 101 temp x 3 weeks...seems to have started after Tysabri infusion.  Very poor appetite and persistant diarrhea in PM and early AM hours.  The fevers tend to be patterned in nature occuring after TPN is started and persisting 1-3 hours after TPN is stopped.  Final culture shows no growth at 5 days comparably with peripheral and central line.  Stool cultures negative.  Could this be biofilm even if cultures are negative?  Could this possibly be some kind of foreign body rejection considering it has happened with last 3 central lines?  Any feedback welcome. 
lynncrni
You did not state

You did not state specifically what is being cultured in each incidence. I assume the catheter was cultured when it was removed, but what about blood cultures. From the catheter or not, what technique, etc. I doubt this is a foreign body rejection of some kind. 

 

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

www.hadawayassociates.com

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

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

Amy
Amy Tilghman,RN Vital Care

Amy Tilghman,RN Vital Care of Meridian Infusion Pharmacy

The MD ordered blood cultures in all three instances.  It was reported to me by home health that in each instance one set was drawn from a peripheral site and the other directly from the VAD.  In both instances the PICC's themselves were not cultured. 

Thank you Lynn for your response. 

Amy Tilghman,RN Vital Care

kokotis
Kathy Kokotis Bard Access

Kathy Kokotis

Bard Access Systems

contact [email protected]

Marcia Ryder is an expert and the only RN expert to date on Biofilm.  She may have an answer.  Sounts to me as patient is having septic showers after infusion but lines were not in same vessel.  Has this patient been tested for CDifficile as well?

e-mail ryder and ask her opinion

kathy 

 

Kathy Kokotis

Bard Access Systems

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