[HSF] PVE

[Nasser F. Abou'Seada]

Dear Bob
that applies to your day and every other day ....
Kindest Regards

NFA

On 5/5/07, rwmfglycar at aol.com <rwmfglycar at aol.com> wrote:
>
> In my day the instruments used for removal would all be dropped with the
> valve into the same kidney dish and leave the table together. If further
> debridement was needed those instruments would also be discarded. Then of
> course there would be efforts to cleanse the valve bed.
> Bob
>
>
> -----Original Message-----
> From: nfaabouseada at gmail.com
> To: OpenHeart-L at lists.hsforum.com
> Sent: Sat, 5 May 2007 4:32 PM
> Subject: Re: [HSF] PVE
>
>
> 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
> >
> >
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>
>
> -- Nasser F. Abou'Seada,
> MB,ChB,MD,FRCSEd,ChM,ChD C/Th,
> FICS,FISCVS,FSSRCTS,FHMS,MESC
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-- 
Nasser  F.  Abou'Seada,
MB,ChB,MD,FRCSEd,ChM,ChD C/Th,
FICS,FISCVS,FSSRCTS,FHMS,MESC