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Treatment of an Infected Silicone Right Atrial Catheter with Combined Fibrinolytic and Antibiotic Therapy: Case Report and Review of the Literature
Author(s) -
Lewis John A.,
Lafrance Richard,
Bower Robert H.
Publication year - 1989
Publication title -
journal of parenteral and enteral nutrition
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.935
H-Index - 98
eISSN - 1941-2444
pISSN - 0148-6071
DOI - 10.1177/014860718901300192
Subject(s) - medicine , parenteral nutrition , catheter , sepsis , antimicrobial , antibiotics , surgery , streptokinase , intensive care medicine , chemistry , organic chemistry , myocardial infarction , microbiology and biotechnology , biology
Tunnelled silicone rubber right atrial catheters are commonly used to administer long‐term total parenteral nutrition (TPN), cancer chemotherapeutic agents, and antimicrobial agents. The indwelling devices potentiate platelet‐fibrin thrombi formation, providing a nidus for infection. Although many episodes of sepsis associated with thrombotic tunnelled catheters respond to antimicrobial therapy alone, a significant number require catheter removal. Evidence from case studies and small clinical trials suggests that fibrinolytic agents may increase the response rate and prevent removal of the device when combined with antimicrobial therapy. We present the first case reported of bacterial sepsis secondary to a thrombotic indwelling Hickman catheter for long‐term TPN successfully treated with a combination of streptokinase and antibiotic therapies. (Journal of Parenteral and Enteral Nutrition 13:92–98, 1989)