staph infection of catheter

[cattlekid]

So I'm posting from my local hospital.  I left dialysis on Thursday night with a fever, which is not uncommon for me to have a slightly elevated temperature at the end of treatment but it comes back down within a few hours.

This fever didn't.  I was very tired on Friday and slept the day away and the fever never left.  So I went to the urgent care on Friday afternoon thinking that I might have the beginnings of strep throat (I was the princess of strep when I was a small child).  The urgent care doc (a former dialysis tech at my clinic!!!) took a chest x-ray along with the rapid strep test and also sent me to the hospital for blood cultures.  So as I was literally one step away from lab registration, I got a call from the urgent care doc saying "change of plans, turn right and go to the ER".  She had spoken to my neph, who ordered IV antibiotics. 

So now, two days later, I'm here for the duration.  I have a staph infection in my catheter.  The catheter will be removed today and an ultrasound of my heart will be performed to ensure that the infection has not lodged in a heart valve.  More IV antibiotics will be administered later today as well.  I will be here at least until Tuesday I think because they will want to place the new catheter at that time and then do dialysis here in the hospital.

The ironic part - I'm scheduled for my consultation with my vascular surgeon on Thursday.   

[jbeany]

 

Hospital stays ALWAYS stink!

[MooseMom]

Oh jeez...that's really scary news, even for a Princess of Strep!  Thank goodness they caught it, but it's a crappy way to spend the weekend.

May I ask...what accounts for the fever you often get after dialysis?  You say it is not uncommon...is that true for most people on D or just for you?  What is your body reacting to that causes fever?  I'm really curious.  After I had a hysterectomy 2 years ago, I experienced slight fevers and was told as I left the hospital that if you get a fever of more than 101, call the doc, so this led me to believe that lowgrade fevers after surgery were common.  I'm still now sure why, though.  So, what is it about dialysis and surgery that causes lowgrade fevers?

See, there's something you can think about while you are sitting there in the hospital.  You can annoy the docs and nurses with Questions from MooseMom.

Anyway, I hope you get better very soon and will let us know what the medicos find.

[cattlekid]

Personally, I think the post-dialysis elevated temp is because I spend the treatment time wrapped up in a big fluffy blanket   

The post-dialysis temp for me is usually around 99, not too elevated.  The interesting part is that I always have the most bizzare dreams at night after a treatment.  And I wake up drenched in sweat.  I've never done any investigation but I've always felt it may be because my body is just readjusting to the "new normal" after the rapid fluid and toxin removal.  I always feel fine the mornings after dialysis so I've never really thought too much of it. 

I'll have to ask my neph tomorrow when he stops by.  He is always amazed by the questions that I manage to come up with. 

Oh jeez...that's really scary news, even for a Princess of Strep!  Thank goodness they caught it, but it's a crappy way to spend the weekend.

May I ask...what accounts for the fever you often get after dialysis?  You say it is not uncommon...is that true for most people on D or just for you?  What is your body reacting to that causes fever?  I'm really curious.  After I had a hysterectomy 2 years ago, I experienced slight fevers and was told as I left the hospital that if you get a fever of more than 101, call the doc, so this led me to believe that lowgrade fevers after surgery were common.  I'm still now sure why, though.  So, what is it about dialysis and surgery that causes lowgrade fevers?

See, there's something you can think about while you are sitting there in the hospital.  You can annoy the docs and nurses with Questions from MooseMom.

Anyway, I hope you get better very soon and will let us know what the medicos find.

[cattlekid]

The latest update:  catheter is out.  Heart ultrasound has been done.  If there is anything odd on the heart ultrasound, I'll have to have a transesophogeal ultrasound, where they sedate you and then put the ultrasound probe down your throat to get a better look at the heart.  The ultrasound tech didn't seem too alarmed about anything he saw on the ultrasound but I'll know more tomorrow.

So far, my cultures from Friday and Saturday are both positive for staph.  Now that the catheter is out, I'll get another bag o' Vancomyocin tonight and then they'll take another culture tomorrow morning.  B/c it takes 24 hours for the culture to grow, I'll have to be here at least until Tuesday morning.  If the culture comes back negative on Tuesday, they'll replace the catheter, do dialysis here in the hospital again and then hopefully be out of here on Tuesday night or Wednesday morning. 

[monrein]

Horrid, horrid horrid...and this is exactly why I hate caths.  So sorry this happened but glad it's being treated. 

[sullidog]

Keep us posted!  At least you didn't have a dum nurse that blaimed your chills on the air conditioning like I did, that nurse has since left the unit.
As for the fevers after dialysis, I have not experienced that.

[MooseMom]

Thanks for the update.  Keep 'em coming.   

[billybags]

Hope every thing goes Ok.

[cattlekid]

Today's update....

Today is going to be even more of a snoozefest than yesterday.  I saw all three doctors already and at this point, they are not even giving me more antibiotics, they are just going to let the ones I already have percolate.  They are waiting until tomorrow morning's blood cultures to formulate the next plan of action.  They are talking daily outpatient IV antibiotics and possibly a break from dialysis at least for tomorrow.  According to my neph and the Infectious Disease doc, because I am peeing with regularity, they would prefer to err on the side of caution before putting in another tunneled cath.  I am just hoping that I get out of here tomorrow as I can get the IV antibiotics 10 minutes from home at the urgent care clinic and they are open until 8 PM so I can go after work. 

So today I'm just chilling.  I have a conference call at 2 PM and that's it.  Otherwise, it's just knitting and Internet for me until bedtime LOL   

[dialysisadvocate]

I am sorry to hear about your infection. Yes, sometimes when the temperature on the machine is higher than it should be you can run a temperature. Often, when a patient complains of being cold the staff raise the temperature on the machine which raises the temperature of your blood. This can cause, again, an elevated temp. My Dad had that once which resulted in a temp of 101. It is usual procedures, in most units, as I unerstand, for staff to do a blood culture when a patient runs a temperature. It might even be standard practice.

In my experience, reviewing surveys (inspection reports) from many different states, those who conduct/perform catheter care do not follow the infection control policies and procedures. This is why it is imperative that patients educate themselves as to what staff will be doing to prevent an infection. There are certain things that staff must do. I have observed, many times, RNs who put on gloves without hand hygiene (washing hands), they then touch contaminated surfaces e.g. treatment cart, machines, etc then go to touch the patients access site area/catheter with contaminated gloves.  I don't recall, did you say you had MRSA (a form of staph that is resistant to many antibiotics). I would guess, that staff did not follow the correct infection control when taking care of you. I would suggest that you ask for the policy, from your unit, so you can see what staff are suppose to do. You can approach it by stating, "I would like to be more educated and help the staff and know what is happening. Can I have a copy of your facility's policy on catheter care related to infection prevention' Now, many facilitie will not give you this infomration and if you can not get it, I can provide other resources. If you now what your staff are suppose to be doing, then you can remind them when they forget. Often they touch your clothes with the same gloves that are going to be doing the catheter care. It shocks me that RNs, per the surveys, do not follow these practices. 

It is my belief, considering infection control deficiencies remain the most frequently cited are during inspections, that providers are NOT educating the right way, they are not having effective unit level supervision and staff just dont get it or dont care

You can also file a complaint with the state and they can investigate. You can remain anonymous, I can file for you if you want and I give my name, therefore, the report will come to me and I can forward to you. The state can check to see how many patients acquired an infection and they can observe staff. They can alslo look to see if the facility is tracking this data as they are suppose to... many do not. however, being there are no consequences for facilities, when things are not done correctly, often there is no change

opinions above are from
Roberta Mikles BA RN
Dialysis Patient Safety Advocate
www.qualitysafepatientcare.com

[Cricket]

I certainly hope you get better - real SOON!!!!!
I too had a fever (only once) after treatment.  It lasted a few hours and 2 Tylenol took care of the problem.  No one gave answers as to why the fever to begin with.
Still on a cath.  MANY snags, hold ups and screw ups about my graft being done.    No doubt about it - someone dropped the ball, big time 

[texasstyle]

Me too. Hope you get better real soon that is. I learned a little bit about staph infection whe my husband got it once. Staph is on your skin to begin with. I think it just needs an entry point to begin an infection. Exzample:dry cracked skin etc.. Yeast is on your skin also. It means "little grapes" or something like that because that's what it really looks like under a microscope. Vancomyacin is a broad-spectrum anti-biotic. I'm sure it has many purposes but I know they often start giving it until a culture comes back. If a particular bacteria is identified, they may give an anti-biotic just for that bacteria. Sometimes vanco is given the whole time. I can see why they did tests of your heart. That would be serious if you had periocarditis. (infection of the heart)  You in the right hands for now and I know you'll be doing great in no time. Knitting? Great for you! I tried chrocheting once when I was 14. The only thing I could do was a straight line with it lol. 

[MooseMom]

In case you're done with your knitting and you have been eagerly awaiting more MooseMom questions, could you tell me what exactly a "tunneled cath" is?  Is it the same as a "perma cath"?  Are all hemodialysis caths the same?

[cattlekid]

Hello MooseMom!  I'm waiting for dinner and watching the news so I figured I would do a little research.

From Wikipedia:
If a patient requires long-term dialysis therapy, a chronic dialysis catheter will be inserted. Chronic catheters contain a dacron cuff that is tunneled beneath the skin approximately 3-8 cm. The tunnel is thought to add a barrier to infection. 

This is the type of catheter that I had.  I was on my second tunneled catheter.
From what I've seen a permacath is a synonym for a tunneled cathter.  Doesn't seem like there is any difference between the two that I can discern.
 

In case you're done with your knitting and you have been eagerly awaiting more MooseMom questions, could you tell me what exactly a "tunneled cath" is?  Is it the same as a "perma cath"?  Are all hemodialysis caths the same?

[Cordelia]

I'm so sorry you have had to experience this.......I too have a central line access catheter in my chest and have had no infection (I've had it for one year) I've always been worried about getting an infection......I do the "shower technique" I've been doing that since this past December.

I hope you can get rid of the infection, good luck   

[sullidog]

I don't know maybe you already mentioned this, but why don't you have a fistula?

[cattlekid]

I just started dialysis at the end of January.  At the time, I had four people lined up to be tested to be a live donor.  So I made a deal with my center - I would get the vein mapping done and hold off on the fistula until I knew what was going on with my donors.  Unfortunately, three of my donors failed testing with the last one just failing two weeks ago (my mom).  So I scheduled the consultation with my vascular surgeon for this coming Thursday - go figure.  I got this far without a problem with the catheter and now this.   

I don't know maybe you already mentioned this, but why don't you have a fistula?

[looneytunes]

Wishing you a speedy recovery.   

[MooseMom]

Thanks for the info re catheters.  Now I'm all edukated.

[cattlekid]

Today's update:  The trio of doctors has agreed that since I have not had a fever for quite a while and my cultures have come back negative, I can get my catheter replaced, get dialysis today here in the hospital and then GET OUT OF HERE!!!!   

Should have not had breakfast but didn't know 100% that they were going to agree on the catheter placement today.  My nurse has stated that they will discharge into the night so I'm confident I'll be going home today.

Woot!!!   

[Annig83]

YAY! That is reat news!  Good luck, and glad that everything is getting better quickly 

[MooseMom]

Oh, that's great news!  Just be careful with yourself.

[jbeany]

Ah, there's no place like home!

[dyann]

I understand the staph infection from caths,  i have had 3 last one was in may of last year from a cath and I ended up with a DVT from it, spent 3 weeks in hospital.  my Neph didn't want anymore cath placements, so of course got a fistula well 4  attempts at one and the fourth took,  well I was all set for another placement of a new fistula as what is being called a back up because the one I currently have is going bad, but went into hospital last week with an acute case case pf pancreatitis,(spelled wrong) they have to put a central line i even though I told them it wasn't a good idea because my body would tolerate it well,  my neph was on vacation so what do they do they consult with his partner who states well I dint know much about her so they put the line in.  In the hospital I spike a 102 temp for several days, but no one appears to be worried they do go a head and do cultures.   I am release this past Monday and receive a call yesterday that the culture came back positive for staph blood born infection,  now my procedure is off until treatment is done and cultures come back negative, and they are trying to decide how to treat if they need another line or what.  Maybe next time they will listen to me.  so my heart goes out to you and infections are a pain.  sorry i kind of went off in a rant but sometimes you just have to.