[HSF] Post op mediastinitis

[Tea Acuff]

Whew!

tea


----- Original Message ----
From: "ichfno at aol.com" <ichfno at aol.com>
To: OpenHeart-L at lists.hsforum.com
Sent: Saturday, September 8, 2007 9:34:07 AM
Subject: Re: [HSF] Post op mediastinitis


Ahmed:



We had a run in June at one of our sites and over the course of 2 weeks we had;

1 child previously operated on by local team (TOF), 2 weeks out, developed pseudoaneurysm of the CP site, ruptured, tamponade they repaired; Nothing special noted by them, the child ruptured the site again, 3 days later, again repair, again nothing special; we arrived now 4 weeks out from original op and this time they picked up recurrent pseudoaneurysm on echo before rupture, they took him back to revise and called me to take a look, massive clot in mediastinum, we instituted fem-fem bypass, removed the clot and were greeted with massive bleeding, hole located finger control was not good enough, so clamped at the innominate, and found grossly friable aorta about 2 cm circumferential from old CP site. Heart protected with direct ostial CP and obviously infected aorta (about 50% circumference resected replaced with bovine pericardium, weaned no problem, extubated the next morning, had installed irrigation catheters, irrigated with vanco for 48 hours,
 changed to saline for 48 h
ours removed tubes sent upstairs. Now I am not writing about this apparent success, because over the next two weeks we did 22 children, ranging from arterial switches to Fontans to Ross procedures to aortic arch augmentations, you name it short of Norwoods. On day 5 of our trip, the aortic augmentation came back down stairs with pus draining from lower incision, came in the evening and we took him to OR, mediastinum filled with pus, irrigated with antiobiotics, again Vanco, left irrigation catheters, same rountine as above, went upstairs. That same night later, by about 2 hours the TOF came back down, grossly infected wound, went to OR at daylight, same story. OK, we did not have any further events, completed the trip, no mortality, no child left on vent when team departed, but the arch came back down following a resuscitation upstairs, guess what, medianstinitis, and over the next 4 days 3 more children developed it as well. Just before leaving my team
 cultured the OR, wall
s, Sterillium dispensers, lights, you name it, guess what, all grossly contaminated with psuedomonas, they (the locals) then placed culture dishes in the OR, and guess what psuedomonas. The air conditioning system was checked next and the filters were loaded, with psuedomonas. This all resulted in a major change in cleaning policy (by the way we also reviewed the cleaning and sterilization of the instruments and found some issues). They had stopped operating during this time (2 Weeks) and restarted in August, no infections since and we are here now and hopefully this new system, with routine filter changing at 2 weeks, manner in which ORs are cleaned following the case and then once a week the OR is shut down and fumigated, will eliminate this hideous problem. Diligence and thorough investigation at all levels will most likely turn up your problem. 

WNovick


-----Original Message-----
From: A <alsadd at ksu.edu.sa>
To: OpenHeart-L at lists.hsforum.com
Sent: Sat, 8 Sep 2007 12:26 pm
Subject: [HSF] Post op mediastinitis




Dear Forum Members:

During the past few weeks we had more than our fair share of deep
mediastinitis. We are taking all the usual precautions nothing has changed
but it seems that we are in it for the duration. We consulted ID team and
the Infection control at the hospital. Does any one of the members have more
advice for this frustrating problem? I know the issue is boring and not
exciting but I would appreciate all inputs. Thank you 



Ahmed



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