Join now

Already a member? Sign in

Welcome to Inspire!

What - Inspire is a place where you can connect with people who share your health concerns and find information and advice in groups sponsored by organizations you know and trust.

Why - As a member you can use Inspire to let friends and family know how you're doing, contact others who share your health concerns, receive personalized updates and information about participating in surveys and clinical trials, and more.

How - Joining Inspire is completely free and usually takes less than a minute. Join now!

corner corner corner

RECURRENT LINE INFECTIONS

Daughterhelpingmom
0 Recommendations

My mom has been on HPN for approximately 3 months.
She's had two picc lines and a Hickman catheter. The Hickman has only been in 13 days and already she's back in the hospital with another infection. She is beside herself to say the least. Anyone have any experience with preventing line infections or know of any new techniques that infectious disease are doing to prevent these infections? I've seen information about using alcohol preps over and over again on the ports, tubing, etc. My dad practices pretty good sterile technique. I'm wondering if something else could be causing these infections.

Explore topics in this discussion:

Oxycodone Crohn's disease Pain Famotidine Back pain Vicodin Morphine

42 replies

oleyfriends

Have the hospital nursing staff and/or home visiting nurse watch your father go through the hooking up process. They may have suggestions for him.

You might also talk to your mom's physician about using an antibiotic lock or an ethanol lock. Ethanol locks are in the research phase. To read more about them go to:
Powerpoint presentation: http://www.oley.org/documents/Presentations_for_Web/Opilla%20Oley%202009.pd f
Abstract: http://www.oley.org/documents/Presentations_for_Web/Opilla%20Abstract.pdf

You might want to read the infection section of the Oley HPN Complication Chart: http://www.oley.org/charts/newHPN.pdf

You might want to borrow a video/dvd from the Oley library. There are several conference presentations on this topic. (see http://www.oley.org/video_dvd.html)

Roslyn Dahl
Oley Staff Member
(800) 776-OLEY
dahlr@mail.amc.edu

cp20855

Hello,

I have been keeping a running list of things that might prevent line infections and have posted some of the following previously – sorry for duplication, but it is a tricky (at least for me) to find previous sterility discussions even on this wonderful site.

My husband has had 5 infections over his 5 years on TPN. The bugs that grew from his blood were different every time. He has the leaky guts that someone mentioned, but the doctors think sterility more likely the culprit.

We thought we were being really careful with sterility but somehow the bugs got into the line. I went to the 2009 Oley Conference in Tampa, and there learned several things that we were doing that could have been the cause of the line infections. We don't know if these are real sterility issues or not, but he hasn't had an infection since last June!


1) Don't pull back the plunger of a syringe more than once. This is because if you happened to touch the plunger sides, once the plunger goes back into the tube any bugs could scrape off into the tube, and then the next time you pull back the plunger the bugs can get into whatever liquid is filling the tube. (Hope this makes sense!)
One of our home nurses had told me to put both vials of vitamins into one syringe so they would mix. Our other medical people say that the vitamins mix just fine in the bag.

2) Use a clean waterproof hard surface such as new clean cookie sheet under your clean surface cover (paper towel?). Then do all the dressing or prepping stuff on that. This is because bugs can travel from under a towel through a wet spot on the towel to the top of the towel where they could get onto something important.

3) Ethanol locks -- manufacturer of his line recommends against them claiming that ethanol degrades polyurethane. We and our care providers have researched this pretty thoroughly and do NOT find evidence to support the idea and ethanol locks will degrade the polyurethane line. (I can post the citations I have if anyone wants them.) He is getting 3 ethanol locks/week.

4) Alcohol wipes wrapped in foil -- just in case my hands might have bugs on them, I've been opening the foil packets along two adjacent sides then folding back the flap, holding the wipe by the foil outer packet.

5) Keep the dogs off the laps and on the floor while prepping. Keep the fans turned off while prepping.

6) Those caps on the little bottles of and insulin may just be dust covers. (I haven't been able to find out for sure.) After you pop them off, swab the tops of the bottles with alcohol.

7) New biopatch with each statlock change.

8) Since we have a well, we put on a heavy-duty (not the Home Depot kind) sediment filter with a backup UV light. Particularly when he had a Hickman, then Groshong, we wondered if our well water could be the problem because he had trouble keeping the long ends of those devices from getting wet – they would nearly slip out from under the things he was using to keep the dressing dry. (They both became infected within about 2 weeks of placement, and the Groshong was the replacement for the Hickman, so it was a very bad month. He has much less trouble with keeping PICC site dry.)

9) Aquaguards worked well on the chest to keep things underneath dry. After I learned about these, our pharmacy included them in weekly shipments at no extra cost.

10) All the stuff that needs to be refrigerated is in one hydration drawer in my fridge. Nothing else goes in that drawer. (If I have too many bags to fit, sometimes I have kept some of it in the package in which they arrived and just rotated and refroze the little freezer packs so the “soup” stayed cold.

11) All the stuff that doesn’t need to be refrigerated is in a cabinet of its own in our kitchen. Nothing else goes in that cabinet.

12) This isn’t a sterility item, but it is something I do now that may help. Wait until right before hookup to put in insulin. Follow insulin with vitamins, then famotidine. These things are added in order of least volume first, then increasing volumes, largest volume last.
Apparently the insulin reacts with the plastic bag somehow, and may not be as available to the patient if it has been in the bag for several hours. Also, since the insulin volume is very small, it could remain in the little tube part of the bag where you inject it unless you flush it on it with the other additives.

13) In order to make sure that we use the proper pump with the type of bag for which the pump is programmed, I am now using duct tape for color codes. Blue is for the hydration pump and for the hydration bags; yellow is for the 2:1 pump and bags; red for the 3:1 pump and (2-chamber) bags. I will be putting a piece of duct tape on each bag when I unpack them into my refrigerator.

That's all I can remember at this moment. I am very interested in any other ideas to make infusion easier and safer.

Best wishes,
Carol

Daughterhelpingmom

Thank you for replying at such length. I certainly will pass this information onto my dad. It's very helpful information.

I definitely agree with the cutting board thing. Sounds like a great idea to have a surface that you can wash everyday. My dad has been putting everything on a towel and working from a new towel everyday. I told him it was a bad idea to use a towel, as the surface cannot be cleaned well. He also puts other things on an old tablecloth, which remains on the table for several days. He's probably picking up bacteria from that, too. I also noticed that he uses sometimes no gloves, but he says that he alcohol's his hands everytime he administers or does anything with the HPN. I told him that sterile gloves wouldn't be a bad idea. What are your thoughts on using gloves?

thank you so much

cp20855

Hi, tell your dad -- NEW cooky sheet or jelly roll pan, NOT cutting board (especially not a wooden one). Cover with paper towel, then change paper towel after use and wipe down the cooky sheet with alcohol.

Boxed rubber gloves aren't sterile -- they are intended to keep the nurses safe from patients' body fluids, I think. He should definitely be washing his hands every time with hot water and antimicrobial soap that has (at least, that's my opinion), dry with fresh paper towel. (I think the soap that is in a bottle might stay "cleaner" than a bar, but again that's just my opinion.)

If he is changing dressing, he should definitely be wearing sterile gloves. They are usually right inside the sealed dressing package.

Good luck!

Novagrad

Yup. I have had so many almost deadly line infections. My first hickman infection was less than two months after getting the line. I use ethanol instilled in each line (two lines for my hickman) each night before bed. I then take what's left of the ethanol out in the morning before I use the line. It's been wonderful! No infections (knock on wood)! My doctors are truly amazed at how well this has worked for me! The pharmacy needs to know exactly which line you have so they can figure out how much ethanol to give you. Each of my lines holds 2.5cc of ethanol. You don't want it to leak in the bloodstream because it's extremely painful. So when you inject it, do it slowly.

Mimi

Novagrad

By the way, the manufacturer of my line does not recommend against the Ethanol. They just said that they don't have information on how long this can be done. But not once did they recommend against it. I use the ethanol every single night. Also, I see you live close by to me. Which home health company does your dad use? I used to use Coram (before my insurance changed me) and they were excellent and knew all about the ethanol locks. Good luck - ethanol is the way to go (in my opinion)!

Mimi

cp20855

mimi,
who is mfr of your line? is it silicone or polyurethane?

we also use coram. they have been terrific.

thanks,
carol

ps ...except their antiquated billing system...

randynoguts

we just get a case of 'blue" pads from the pharmacy. use a new one each night. they give them to us free. maybe ask about that. it would be cheaper for them than infection treatment.

cp20855

randynoguts,
are blue pads same thing as biopatches? kind of lifesaver candy-sized with a slit that slips over the line?

if not, please tell more about them!

thanks,
carol

Daughterhelpingmom

Hi Mimi

Thanks for your reply. My mom is using Coram. I won't say that everything has been perfect with them. They've lost lab work and many times couldn't locate it. They've come late with the bags so hookup time was inconvenient. I guess all in all, they've been just okay. As far as the ethanol lock goes. Do you do that yourself or someone do it for you? I was wondering what happens if it gets in the bloodstream. May not be something that my dad can handle.

My folks live in Framingham, Mass. How close are you to that area?

Daughterhelpingmom

I'd like to know too what the blue pads are? Is it something to place your supplies on before doing the injection or does it fit over the injection site? If you have a Hickman catheter, does it matter what type of dressing they use? We were told conflicting information about the clear versus the nonclear dressing.
Thanks

daviandsteve

In March 1983, my weight was seriously low (77) - I felt like I was disappearing! So I welcomed the intrusion of TPN into my life. When I arrived home from three weeks in the hospital, newly trained in the care of Hickman catheters and the administration of TPN (actually, we called it "hyperal" in those days), I had three new pieces of furniture: an IV pole, a bedside commode, and a rolling, adjustable hospital table. I still have all three, although the pole is mostly for decoration. I don't know how I would manage without the hospital table; it's the perfect place to prepare IV solutions or lay out supplies for port access/dressing change! I scrub it with alcohol before starting any procedure, and I keep a small plastic basket on the left side for "spare parts" such as injection caps, syringes,etc. A trash can and sharps container fit underneath. My bedroom is so much cleaner and more private than a kitchen. When I shut the door, I know that no one, especially one of our cats, is going to come in and disturb my efforts to keep things sterile. When traveling, though, I have had to prepare my bag in kitchens, dens and on hotel table tops; I make the best of what's available.

Sure my bedroom looks like a hospital, but the peace of mind is worth it! I'm pretty much resigned to the fact that I will never get off of TPN, and that this is the way things have to be. Five years ago I treated myself to a cheery new comforter, dust ruffle, sheet set, which did improve the look of things.

Another thing I do to prevent infection is to scrub, scrub, scrub the injection cap and all tubing ports (including their hubs) with alcohol before injecting anything into them. I have had words with hospital nurses who give piggy back sites, etc., a quick, cursory swipe!

It's good that we're having this dialogue. We all need to be reminded to be vigilant about keeping everything sterile, and to share ideas. I just thought I'd add my two cents' worth!


Davi

Novagrad

Hi!

I live in Shrewsbury, Mass.

I'm sorry that your experience with Coram has not been as good as mine has been. Unfortunately, I don't have them anymore because my insurance company made me switch companies.

Anyway, my line is made by Bard but I'm not sure what it's made of. I know that my doctors know because they have spoken to Bard. Bard tells them that they do not know how long I can go on injecting the ethanol, but I've been doing it religiously each night since April. Actually, I was doing it three times per day way into May, but then I switched to each night when the active infection had finally gone away. The hospital had come up with the information as to how much ethanol to use. It's 70% ethanol and each line will hold up to 2.5cc. If I inject it too quickly and it gets into the bloodstream, it causes intense body pain but only for a minute. But the pain is severe, though that's only if you quickly inject the ethanol. If you do it over about 20-30 seconds, you will be fine. I still think it's totally worth it, as I was getting severe blood infections on a regular basis before this (like almost every month).

Oh, and I agree with Davi and everyone else - be generous with the alcohol on the tip ends before connecting to anything!

Good luck!

Mimi

Novagrad

Oh yeah, and I don't use the biopatch because I'm allergic. I'm also allergic to tegaderm so I use the IV 3000 dressing cover which is still clear.

Mimi

cp20855

The ethanol lock is just a syringe filled with ethanol -- use it instead of heparin after TPN and saline flush.

If you know how much your line holds, couldn't you flush push in that amount of ethanol and then stop? The idea is to clean the catheter. Ask your medical folks.

Daughterhelpingmom

Thank you Davi for your response. I welcome any and all suggestions on how to make this a more sterile process and infection free my mom. It has got to get better for her.

daughterhelpingmom

Daughterhelpingmom

So when you inject the ethanol, you don't inject completely through the line and you draw it out after so many hours? She can't use heparin, she's allergic, so they use saline to flush the line after disconnecting the HPN.

Novagrad

Yes, that's correct. You instill the ethanol, not "inject" it. It just sits in the line for a period of time, usually about 8 hours. Then you withdraw whatever is left (usually very little) after that period of time and then you flush with saline. Never use the line with the ethanol sitting in it. I use it each night in each line (I have a double lumen hickman). I have basically no immune system so my doctors are adamant about this. However, most studies using ethanol only talk about using it one to three times per week for prophylaxis. When I had the active infection, I used it three times per day. But I think that my doctors and I feel more comfortable about using it every night instead of a couple of times per week knowing how many almost fatal infections I have had. Good luck! It's been a true lifesaver for me!

Mimi

Daughterhelpingmom

Thank you so much for this information. I will pass this onto my dad. My mom also has no immune system. With severe Crohn's disease, how can you.
She had two rounds of Remicade but because of the 4 line infections, hasn't been able to go back to that. Right now she's taking nothing for the Crohn's, which scares us.

Good luck to you. Maybe one day we can all meet up and share stories.

Regards
Dawn

Daughterhelpingmom

Thank you so much for this information. I will pass this onto my dad. My mom also has no immune system. With severe Crohn's disease, how can you.
She had two rounds of Remicade but because of the 4 line infections, hasn't been able to go back to that. Right now she's taking nothing for the Crohn's, which scares us.

Good luck to you. Maybe one day we can all meet up and share stories.

Regards
Dawn

Add to the discussion

Don't have an Inspire account? Join now!

Forgot password?

Helpful links from the Oley Foundation

Group leaders

You