Tunnel infection

Catheter malfunction, and exit site and tunnel infection. 

Peritonitis Exit-site infections Tunnel infections... 

Exit-site infections present with purulent drainage at the site. Erythema may or may not be present with an exit-site infection. Tunnel infections are generally an extension of the exit-site infection and rarely occur alone. Symptoms of a tunnel infection may include tenderness, edema, and erythema over the tunnel pathway, but are often asymptomatic. Ultrasound can be used to detect tunnel infections in asymptomatic patients. Exit-site infections caused by S. aureus and P. aeruginosa often spread to tunnel infections and are the most common causes of catheter-infection-related peritonitis. 

Intranasal S. aureus increases the risk of S. aureus exit-site infections, tunnel infections, peritonitis, and subsequent catheter loss.49 Several measures have been used to decrease the risk of peritonitis caused by S. aureus, including mupirocin cream applied daily around the exit site, intranasal mupirocin cream twice daily for 5 days each month, or rifampin 300 mg orally twice daily for 5 days, repeated every 3 months.49 Mupirocin use is preferred over rifampin to prevent the development of resistance to rifampin, although mupirocin resistance has also been reported.49 Other measures that have been used to decrease both S. aureus and P. aeruginosa infections include gentamicin cream applied twice daily and ciprofloxacin otic solution applied daily to the exit site.49... 

Catheter malfunction, exit site, and tunnel infection. 

Table 45-8 hsts the numerous medical comphcations of PD. An average PD patient absorbs up to 60% of the dextrose in each exchange. This continuous supply of calories leads to increased adipose tissue deposition, decreased appetite, malnutrition, and altered requirements for insulin in diabetic patients. Fibrin formation in dialysate is common and can lead to obstruction of catheter outflow. Infectious comphcations of PD are a major cause of morbidity and mortality and are the leading cause of technique failure and transfer from PD to hemodialysis. The two predominant infectious complications are peritonitis and catheter-related infections, which include both exit-site and tunnel infections. 

Criteria for complicated CLABSI Severe sepsis Thrombophlebitis Metastatic infection Tunnel infection with fever... 

Tunnel infection and negative blood culture 7-10 days... 

PD complications can be divided into acute or chronic and infectious or noninfectious. Imaging with ultrasound, CT, and eventually MRI can contribute significantly to appropriate treatment of many situations (Taylor 2002). Acute catheter dysfunction may be caused by malposition and can be seen on a plain abdominal radiograph. Development of inguinal hernias is caused by the permanently increased intra-abdominal pressure, and herniotomy is frequently needed. Acute respiratory distress should raise suspicion of hydrothorax caused by thoracic leakage of peritoneal fluid (Rose and Conley 1989). A chest X-ray can show this complication (Fig. 21.3). Infections of the exit site, the subcutaneous tunnel, and peritonitis are the most common infectious complications. Proper treatment with intraperitoneal antibiotics is mandatory. The incidence of peritonitis is estimated to be one infection per 13 treatment months. Recurrent peritonitis may lead to catheter removal. Tunnel infections typically show pericatheter fluid collection, and US is important for early detection and follow-... 

Extensive infection Access less than 1 month old Tunneled Cuffed Catheters... 

Catheter-related infections generally occur at the exit site or the portion of the catheter that is tunneled in the subcutaneous tissue. Previous infections increase the risk and incidence of catheter-related infections. 

Peripheral neuropathies maybe widely disseminated or focal. Patients with disseminated polyneuropathy, whether demyelinative or axonal, usually demonstrate distal sensory and/or motor impairment. Multifocal neuropathy, also referred to as mononeuropathy multiplex, is often a consequence of lesions affecting the vasa nervorum, the blood vessels that supply peripheral nerves. The most common diseases to compromise the vasa nervorum and cause infarction of nerve fascicles are diabetes mellitus and periarteritis nodosa. Other frequent causes of mononeuropathy multiplex include infection (e.g. Lyme disease and leprosy) and multiple compression injury (e.g. bilateral carpal tunnel syndrome). When mononeuropathy... 

Infection is significantly reduced if the plants are covered with a rain shelter (low tunnel) during the harvest. 

In a prospective, double-blind study, the use of either vancomycin -I- heparin -I- ciprofloxacin or vancomycin - -heparin flush solution, compared with heparin alone, significantly reduced the infective comphcations associated with tunnelled central venous lines in immunocompromised children. Neither antibiotic could be detected after flushing and there were no adverse events (30). 

If a centrally placed venous catheter is required, tunnelling of the catheter under the skin from the entry point to the appropriate vein minimizes the risk of infection,... 

Wilted plants with healthy roots may be infested with strawberry crown moth larvae or strawberry crown borer larvae. Crown borers are " snout beetles and crown moths are large, clear-winged moths. Both pests lay eggs on strawberries. The resulting grublike larvae burrow into plant crowns and cause wilting and death. Cut crowns of wilted plants in half. If you find a large tunnel, your plants are infected with one of these pests. The only care is to dig up and destroy these plants... 

Damage Larvae and adults live in galleries engraved in a radiating pattern under the bark of elm trees. The tunneling does not cause serious damage to the trees. However, adults carry Dutch elm disease fungi on their bodies and infect healthy trees when they bore into bark. 

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