Welcome to Scribd, the world's digital library. Read, publish, and share books and documents. See more
Standard view
Full view
of .
Save to My Library
Look up keyword
Like this
0 of .
Results for:
No results containing your search query
P. 1
Foreign Body Infections

Foreign Body Infections



|Views: 155 |Likes:
Published by api-3712326

More info:

Published by: api-3712326 on Oct 14, 2008
Copyright:Attribution Non-commercial


Read on Scribd mobile: iPhone, iPad and Android.
download as PDF, TXT or read online from Scribd
See more
See less





"Foreign Body" (Device) Infections
Implanted Devices Vulnerable to Infection
Indwelling Intravenous catheters
Prosthetic cardiac valves
Prosthetic orthopedic devices (joint replacements) Cerebrospinal fluid
shunts/Ventriculostomy drains Peritoneal dialysis catheters
Arterious-venous anastomoses (dialysis) Vascular grafts

Mesh soft tissue support
Silicon Implants (plastic surgery)
Cardiac pacemakers

CPT Coding
Complication of an Internal Prosthesis, Implant or

Graft--infection or Inflammation
996.60 Unspecified 996.61 Cardiac 996.62 Vascular
996.63 Nervous system

Urinary catheter
Genitourinary other
Joint prosthesis internal
Orthopedic other internal
Other Internal prosthesis
Intravascular Device Infections Types (Examples)

Peripheral Short Lines (Angiocath)
Peripheral Long Lines (Landmark)
Percutaneous CVP (Cooke triple lumen)
Pulmonary artery catheter (Swann-Ganz)
Tunnel/Cuff (Broviac)

Implanted Port (Port-a-Cath)
Intravascular Device Infections
Risk factors

Cutdowns > Percutaneous Insertion Central lines > peripheral Femoral >

Jugular \u2022 Subclavian
Long duration \u2022 short duration (< 72 hours) Polyvinyl chloride \u2022 Teflon or
silastic Direct insertion \u2022 tunneled Frequent access > Infrequent access
Parenteral nutrition \u2022 noninitiative fluids \u2022

Tegaderm \u2022 open air dressings

Intravascular Device Infections
Contamination of Intradermal Insertion
wound (+ bleeding)
Formation of intravascular "fibrin

Colonization of catheter, formation of
"bifilms" and "macrocolonies" Infection of "fibrin sheath" Release of
"planktonic" organisms Local or generalized intravascular
Intravascular Device Infections

Common organisms Coagulase-negative staphylococci Staph. aureus (including MRSA) Candida albicans Klebsiella - Enterobacter Enterococci (now including VRE) Pseudomonas aeruginosa

Intravascular Device Infections

Unusual organisms Corynebacterium jeikeium Pseudomonas cepacia Serratia marcescens Acinetobacter calcoaceticus Torulopsis glabrata Malassezia furfur Candida lusitaniae

Intravascular Device Infections

Clinical Manifestations Occult bacteremia Exit site Infections "Tunnel" infections
Sepsis/septic shock
Septic thrombophlebitis - peripheral or
central vein

Metastatic spread - eyes, CNS, lungs operative sites, other prosthetic devices,
Intravascular Device Infections
Line Removal

Removes focus of infection
Shortens duration of therapy

Reduces chances of metastatic spread Cons
Local/systemic antibiotics may cure Multiple lines/uncertain source
Limited access
Need for line may be time-limited
Intravascular Device Infection
Treat through all incriminated venous
lines and lumens
Synergistic/additive combinations Antibiotic "lock" technique
(heparin/antibiotic compatibility)
Don't use vancomycin unnecessarily Duration determined by response
presence of metastatic infection
Intravascular Device Infections
Block adhesion of organisms new polymers, detergents, disaccharides
Prevent bacterial growth impregnated antibiotics, infused antibiotics, antibiotic
"lock" technique
Intravascular Device Infections
Criteria for "significant" bacteremia < 48 hours to positive result 2/2 bottles
positive Repeated cultures positive
Intravascular Device Infections

Other culture criteria Semiquantitative cath tip pneltive Pus expressed from tunnel positive Persistent bacteremia despite appropriate Rx Higher level bacteremia from incriminated

Intravascular Device Infections
Treatment options Line removal Antibiotics Both

Strategy, sites of new lines
Neurologic Device Infections Types of Devices (Examples)
External ventricular drains


Subcutaneous access ports (Ommaya) Ventriculo-peritoneal shunts (Hakim) V-atrial, V-jugular, V-pleural Subarachnoid screws/bolts (El Camino)

Neurologic Device Infections
Epidemiology/Risk Factors
Timing close to operation (<2 months) Overall rates 5-35%

Thin cortex \u2022 thick cortex High protein > low protein Low pressure > high pressure July \u2022 rest of academic year Repeat surgery \u2022 initial surgery Head shaving night before \u2022 shave at

Neurologic Device Infections

Coagulase-negative Staphylococci
Staph. aureus
Corynebacterium sp.
Propionibacterium acnes
Enteric gram negative rods

Candida sp.
Neurologic Device Infections Clinical Manifestations
Shunt malfunction-headache, vomiting,

irritability, mental status changes, coma Shunt reservoir doesn't "pump" properly Fever (not invariably present) Peritonitis (VP shunts) Bacteremia/sepsis/nephritis (V-A and V-J)

Neurologic Device Infections

Activity (3)

You've already reviewed this. Edit your review.
1 thousand reads
1 hundred reads
paroparo4457 liked this

You're Reading a Free Preview

/*********** DO NOT ALTER ANYTHING BELOW THIS LINE ! ************/ var s_code=s.t();if(s_code)document.write(s_code)//-->