THÔNG TIN TÀI LIỆU
the addition of expanded coverage such as vancomycin If there is a suspected intra-abdominal source, piperacillin/tazobactam can be substituted for cefepime to treat for enteric organisms Local antibiotic resistance patterns should determine the antibiotic choice Persistent colonization of CVCs may respond to installation of antibiotic or ethanol into the lumen for 12 to 24 hours (antibiotic lock or ethanol lock) Other Complications Other complications related to indwelling catheters can occur, albeit rarely Direct injury to the exit site can be a result of either erosion of tissue by the Dacron cuff of an externalized catheter or breakdown of the skin site from vigorous cleansing This condition can lead to a localized infection On physical examination, excoriation, erythema, tenderness, or purulent drainage is present at the exit site of the catheter Select patients with a localized site infection who are afebrile and well appearing, have a normal leukocyte count, and have close follow-up may be managed as outpatients with oral antibiotic therapy As previously mentioned, phenytoin and diazepam can interact with the silicone lining of the catheters and the administration of these medications through Silastic catheters should be avoided if possible In addition, a large volume of saline flush should be administered between medications that are incompatible with each other, such as calcium and bicarbonate ENTERAL FEEDING TUBES Background A stoma, derived from the Latin word for “mouth,” is an opening from the GI or urinary tract to the outside of the body A gastrostomy is a surgically, endoscopically, or radiologically created stoma that provides access to the stomach from the level of the skin A jejunostomy is a surgically created stoma that brings the jejunum to the skin surface Gastrostomy is performed most typically in children who are unable to take adequate oral nourishment for a prolonged period The inability to tolerate sufficient oral feedings can be related to numerous conditions, including esophageal atresia, chronic malabsorptive syndromes, significant craniofacial abnormalities, tracheostomy, neurologic impairment, severe gastroesophageal reflux, esophageal burns, chronic systemic diseases, and, rarely, anorexia nervosa Jejunostomy feedings are used when postpyloric feeding is required and carried out in such patients as those with delayed gastric emptying, recurrent aspiration pneumonia, or severe
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