Re: Surgical Prophylaxis for MVP
From: art fougner, md (evsono@pipeline.com)
Wed Sep 20 12:58:42 2006
Anna
In our hospital system, standing orders - pre-printed or otherwise have
been ix-nayed. Funny how this all works.
Art
At Wed, 20 Sep 2006, Meenan, Anna wrote:
>
>Which is incredibly amusing, because whenever I object to something
>on a preprinted order sheet, the nurses always assure me that those
>are just there to make life easier for me and I am free to order
>whatever I want. LOL
>
>Anna Meenan, MD
>
>>I am sure others have found this - once there are pre-printed orders you
>>can't vary from that without someone in the hospital heirarchy saying
>>you are not following the "standard of care".
>>
>>At Tue, 19 Sep 2006, Garry E. Siegel, M.D. wrote:
>>>
>>>There are AHA guidelines from 2001, I think, and MVP without murmur is
>>>not a lesion requiring prophylaxis for endocarditis.
>>>
>>>Ancef is appropriate for the surgical site, of course.
>>>
>>>Garry
>>>
>>>At Tue, 19 Sep 2006, ainsron wrote:
>>>>
>>>>That is not correct, prophylaxis is indicated for TAH or Vag Hys, per ACOG
>>>>guidelines for surgical site infections - endocarditis prophylaxis is
>>>>another issue. It is not recommended for laparoscopy.
>>>>
>>>>Ronald E. Ainsworth, MD, FACOG
>>>>
>>>>-----Original Message-----
>>>>From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Kim Elise
>>>>Goldman
>>>>Sent: Tuesday, September 19, 2006 5:18 AM
>>>>To: Multiple recipients of list OB-GYN-L
>>>>Subject: Re: Surgical Prophylaxis for MVP
>>>>
>>>>PS Abdominal surgery without entry into the aerodigestive tract is
>>>>not an indication for endocarditis prophylaxis per AHA guidelines.
>>>>(EG vag hyst indicated for prophylaxis but TAH probably not indicated.)
>>>>
>>>>Kim
>>>>
>>>>On Sep 19, 2006, at 7:44 AM, Joanne Bulley, MD wrote:
>>>>
>>>>> Hi folks,
>>>>>
>>>>> With a fair number of women who have MVP - without arrhythmia and with
>>>>> the subtlest of murmur - when doing a TAH (or other hyst) would you
>>>>>
>>>>> a) standard prophylaxis with cefazolin (Ancef)
>>>>>
>>>>> b) MVP / lower cardiac risk prophylaxis with ampicillin?
>>>>>
>>>>> My hospital pre-printed orders for the cardiac prophylaxis suggests
>>>>> just
>>>>> Ampicillin. But it also suggests it is needed for MVP only if
>>>>> there is
>>>>> regurg or thickened leaflets.
>>>>>
>>>>> Many of these women have not told me about the MVP - and it comes up
>>>>> when the pre-op RN at the hospital asks the question and then who
>>>>> knows
>>>>> where the echocardiogram (if any) was done - and I get the phone call
>>>>> "she needs prophylaxis for MVP"
>>>>>
>>>>> What do you do in your institution? (I am always curious about how
>>>>> folks
>>>>> do things in different places around the globe - as there are so many
>>>>> variations because a lot of what we do does not have "final" EBM
>>>>> answers.)
>>>>>
>>>>> --
>>>>> Joanne Bulley, MD
>>>>> Keene, NH, USA
>>>>>
>>>--
>>>Garry E. Siegel, M.D.
>>>Private Practice
>>>Roswell, GA
>>>
>>--
>>Joanne Bulley, MD
>>Keene, NH, USA
--
art fougner, md
"May The Wings of Liberty Never Lose a Feather." - Jack Burton
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