Re: lost PortaCath catheter
From: Anna Meenan, MD (annam@uic.edu)
Thu Feb 13 19:13:24 2003
Lady, you need to talk to your own doctors and stop asking gynecologists
for information you should be getting from your hematologist,
interventional cardiologist, and orthopod. You're an RN, for
chrissakes. Either that or you're the Troll of all Trolls.
--
Anna Meenan, MD
At Thu, 13 Feb 2003, lvs1 wrote:
>
>mine is in the rt ventricle its about acouple of inches long lying on the
>bottom I am so scared. thanks for helping and anything else you can send
>thanks, I also have a clotting problem and on plavix, ecotrin, and foltx and
>a high homocysteine level which I don't think is related do you? am I gonna
>die? I am also up for knee surgery arthroscopic on the 6th should I cancel?
>
>>>----- Original Message -----
>From: Gail Waldby <gwaldby@willinet.net>
>To: Multiple recipients of list OB-GYN-L <ob-gyn-l@mail.medispecialty.com>
>Sent: Thursday, February 13, 2003 1:04 PM
>Subject: Re: lost PortaCath catheter
>
>> A few links:
>> From:http://venousaccess.com/complications.htm
>>
>> Fragmentation:
>> Over time, through normal wear and tear, small pin holes may develop in
>the catheter. This is manifested by leaking of fluid (pain and swelling)
>> or inability to withdraw blood.
>> Catheters can occasionally fracture and embolize. If a catheter embolizes
>it usually ends up in the right ventricle or pulmonary artery.
>> This requires removal which is usually performed percutaneously with a
>snare type catheter.
>> A sheath is placed in the femoral or jugular vein. Access is achieved in
>the pulmonary artery or right ventricle. A wire is left in place over which
>> the snare catheter is placed. The snare is inserted and manipulated to
>grab the fractured portion of the catheter. Once snared, it is secured and
>> withdrawn through the sheath.
>> If access to the location of the fractured catheter is difficult it may be
>worthwhile to work through a guide catheter thereby maintaining access.
>> Without the guide catheter manipulation of the snare may cause loss of
>position leading to repetition of steps to regain access.
>> Catheters can be fractured from the pinch off syndrome (above). It can
>also occur if the “locking device” of the catheter on the hub end
>> malfunctions. This is applicable in those catheters and ports that are
>assembled at the hub end.
>> Fragmentation can also occur from inadvertent puncture of the catheter
>while attempting to access a port.
>> In long-term catheters, the external tubing and hub is subjected to wear
>from repeated use. This is especially true where the catheter is
>> clamped. This should be checked occasionally. Hubs and external tubing can
>often be fixed with a repair kit.
>> Fragmentation of catheters can also occur from power injections (e.g.
>contrast for CT). Never use a power injection through a PICC line.
>> Always flush prior to any power injection to evaluate for partial or total
>occlusion. Make sure the line has a large OD and can accommodate the
>> high pressure.
>> Never use a syringe smaller than 10 cc for clearing a port. A 10 cc
>syringe can generate 40 PSI of pressure.
>>
>> http://www.mirs.org/rounds/retrievetxt.htm
>> http://www.mirs.org/rounds/ir_retrievefrm.htm
>> http://www.microvena.com/gooseneck.htm
>> http://www.microvena.com/snare/casestudies/3central-venous.html
>> http://www.sma.org/smj/96jul13.htm
>> http://www.naspe.org/pdf_files/extraction.pdf
>>
>> 2/13/2003 1:45:30 PM, "lvs1" <lvs1@tecinfo.com> wrote:
>>
>> >thanks so very much I am so afraid I don't want it to go anywhere. They
>are
>> >saying that they believe since it has been in there this long it has
>> >probably meshed in with scar tissue but shouldn't they do something other
>> >than a simple x-ray to make sure? If it is stuck what other options do I
>> >have to get it out? are there any other online cardiologists to write to?
>
>>>> >----- Original Message -----
>> >From: Gail Waldby <gwaldby@willinet.net>
>> >To: Multiple recipients of list OB-GYN-L
><ob-gyn-l@mail.medispecialty.com>
>> >Sent: Thursday, February 13, 2003 11:07 AM
>> >Subject: Re: Strep prophylaxis
>> >
>> >> RN, often these can be removed by the interventional radiologist or
>> >Cardiologist using fluoroscopy. I would start with fluoroscopy and see
>if
>> >it
>> >> moves separate from the wall of the heart. If it does, it should be
>easy
>> >to remove.
>> >>
>> >> If it is stuck to the wall of the heart and doesn't move separately
>from
>> >it, it is unlikely to migrate anywhere else.
>> >>
>> >> You could probably get the same information from an echocardiogram.
>> >> Gail Waldby, MD
>> >> Huron Clinic SD
>> >>
>> >> 2/13/2003 12:59:29 PM, "lvs1" <lvs1@tecinfo.com> wrote:
>> >>
>> >> >
>> >> > Date: Thu, 13 Feb 2003 12:59:29 -0600
>> >> >
>> >> > From: "lvs1" <lvs1@tecinfo.com>
>> >> > To: Multiple recipients of list OB-GYN-L <ob-gyn-
>> >> > l@mail.medispecialty.com>
>> >> > Subject:Re: Strep prophylaxis
>> >> >
>> >> > To whom it may concern,
>> >> >
>> >> > I am an RN who had a port a cath for a series or antibiotics
>that
>> >> >
>> >> > was given over several months and had it removed about 5 mo.
>ago. I
>> >> >
>> >> > went and had a chest x-ray done for bronchitis done yesterday
>(non
>> >> >
>> >> > related) and found that a piece of the plastic catheter was
>broken
>> >> >
>> >> > off and still left in the lower part of the heart. All of the
>> >> >
>> >> > cardiologists are saying that it is now meshed in with scar
>tissue
>> >> >
>> >> > and should be left alone and will never pose a problem or travel
>> >and
>> >> >
>> >> > those things are usually put there to be left there
>permanentally.
>> >> >
>> >> > However, I am still afraid this will get loose and travel
>> >eventually,
>> >> >
>> >> > do you have opinions it is on the venous side, low pressure.
>> >Please
>> >> >
>> >> > I need some opinions asap. thanks
>> >> >
>
>>>> >> > ----- Original Message -----
>> >> >
>> >> > From: Lynn D. Montgomery, M.D.
>> >> >
>> >> > To: Multiple recipients of list OB-GYN-L
>> >> >
>> >> > Sent: Thursday, February 13, 2003 7:49 AM
>> >> >
>> >> > Subject: RE: Strep prophylaxis
>> >> >
>> >> > Excellent question Art. They get a local physician to write a
>> >> >
>> >> > prescription – which opens up another age old discussion –
>> >> >
>> >> > complicity…
>> >> >
>> >> > Lynn
>> >> >
>> >> > Lynn D. Montgomery, M.D.
>> >> >
>> >> > Rocky Mountain Women's Health
>> >> >
>> >> > 2835 Fort Missoula Rd., Suite 303
>> >> >
>> >> > Missoula, Montana, 59804
>> >> >
>> >> > 406-549-0978
>> >> >
>> >> > fax 406-549-0987
>> >> >
>> >> > e-mail: apgar10@montanadsl.net
>> >> >
>> >> > -----Original Message-----
>> >> >
>> >> > From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On
>Behalf
>> >> >
>> >> > Of Arthur W. Curtis, Jr.
>> >> >
>> >> > Sent: Wednesday, February 12, 2003 5:23 PM
>> >> >
>> >> > To: Multiple recipients of list OB-GYN-L
>> >> >
>> >> > Subject: Re: Strep prophylaxis
>> >> >
>> >> > Just Curious - How can lay midwives (ie no medical license)
>> >> >
>> >> > prescribe Rocephin??
>> >> >
>> >> > Art Curtis FACOG
>> >> >
>> >> > Worcester, Mass.
>> >> >
>
>>>> >> > ----- Original Message -----
>> >> >
>> >> > From: Lynn D. Montgomery, M.D.
>> >> >
>> >> > To: Multiple recipients of list OB-GYN-L
>> >> >
>> >> > Sent: Wednesday, February 12, 2003 4:53 PM
>> >> >
>> >> > Subject: Strep prophylaxis
>> >> >
>> >> > Hey Listers,
>> >> >
>> >> > I have had several “lay” midwives inquire about strep
>> >> >
>> >> > prophylaxis. Apparently they are using a protocol of
>> >Rocephin
>> >> >
>> >> > via intramuscular injection near the onset of labor. Is
>> >> >
>> >> > anybody aware of any validated protocols using this
>method –
>> >I
>> >> >
>> >> > am not. I know there are some programs doing a bicillin
>> >> >
>> >> > injection protocol, but I don’t think they are concluded
>as
>> >> >
>> >> > yet…
>> >> >
>> >> > Lynn
>> >> >
>> >> > Lynn D. Montgomery, M.D.
>> >> >
>> >> > Rocky Mountain Women's Health
>> >> >
>> >> > 2835 Fort Missoula Rd., Suite 303
>> >> >
>> >> > Missoula, Montana, 59804
>> >> >
>> >> > 406-549-0978
>> >> >
>> >> > fax 406-549-0987
>> >> >
>> >> > e-mail: apgar10@montanadsl.net
>> >> >
>> >>
>> >
>>
