[HSF] PVE

[Nasser F. Abou'Seada]

So apparently he sufferred a low grade endocarditis for 4-5 months. Staph
epidermidis is notorious for such presentation. Nonetheless, the production
of a new infection is dependant on many variables: type of organism,
virulence, size of inoculum, invasiveness .....etc .. so one can not for
sure be certain that a new infection is likely to result from such
contamination. the size of an initial inoculum is very crucial, especially
with a low virulent organism. Was the forceps used just to handle the new
valve? or more than that? apparently with rigorious anti-infectious
techniques used as you have described, the outcome of such contamination (?
small ? big) can not be judged especially with virulence and invasiveness of
such an organism as Coag -ve Staph epidermidis. antibiotics for a lengthy
time sure can supress an infection ? sterilize it? a matter of doubt ...

I would be very hesitant to re-open to change the valve especially with such
rigorious techniques that you described. I use Betadine myself in such
cases. nonetheless I would watch very carefully for markers of infection and
would not hesitate to interfere if I have to, cerainly not before that.
Where to draw the line is a controversial issue for your judgement.

I used to handle the old valve to be removed with an artery forceps, so it
gets attached to the old valve and be removed with it. I am not blaming
anyone, but I would have expected my scrub nurse to tab my hands taking the
old forceps and hand in a new one with exchange of gloves.

Thank you for sharing such event. please keep us posted as to progress.

NFA

On 5/5/07, Edward Bender <ebender001 at charter.net> wrote:
>
> Yesterday I operated on an 80 year old patient I had placed a tissue
> valve (Magna) in the aortic position in Dec of last year.  He also
> has patent grafts from a CABG 9 years previously.  He had continued
> sepsis due to coag -ve Staph epi and large vegetation(s) on the
> aortic prosthesis placed last December.  When I completed the case
> and sobered up this morning, I realized that I used the same forceps
> to place the new valve as I had to remove the old one (with positive
> intra-op gram stain).  We go to great measures to prevent infection:
> frequent glove changes, washing out the annulus with antibiotics,
> debriding all infected tissue, etc.  But I don't think I have ever
> swapped out instruments.  What are the opinions of the forum members
> regarding this?
>
> Ed Bender, MD
>
>
> _______________________________________________
> OpenHeart-L mailing list
>
> Send postings to:
> OpenHeart-L at lists.hsforum.com
>
> To UNSUBSCRIBE, to CHANGE email address, or to view archives:
> http://mmp.cjp.com/mailman/listinfo/openheart-l
>
> All messages transmitted by the OpenHeart-L are subject to the policies
> and
> disclaimers posted at:
> http://www.hsforum.com/listdisclaim
> -----------------------------------------
>



-- 
Nasser  F.  Abou'Seada,
MB,ChB,MD,FRCSEd,ChM,ChD C/Th,
FICS,FISCVS,FSSRCTS,FHMS,MESC