Saturday January 26, 2008
Bedside tip !
Scenario: 48 year old male with end stage renal disease and dialysis dependent admitted from ER with septic shock. Infectious Disease consult recommends to remove Tessio catheter (dialysis) as that could be the most probable source of infection. Patient is a known 'line nightmare' due to multiple previous dialysis catheter procedures. What would be your plan of action knowing that Tessio could be your only line access and patient is hemodynamically unstable ?
Answer: Do not remove catheter unless you have another access in place.
This is true that in case of suspected line infection, all central lines should be removed and new lines be inserted with 'fresh stick' but in situation like above, where line becomes only 'life line', it is not advisable to remove it and end up with 'no access'.
Attempt to obtain line under sonography and if no success, consult vascular surgery or interventional radiology to have alternate line before removing the suspected infected line.