cousin-possible graft infection-help

[Bess]

A couple weeks ago I posted about my cousin's upcoming sx, she had ten years ago a aneurysm of the ascending aorta which was repaired emergently with a graft and a new St. Judes valve. Two weeks ago after they realized she had an infection in the area she had sx and they replaced the valve and graft. A few days ago she was dx with a gram negative infection, taken back to sx yesterday where they cracked her chest again and cleaned out the infection as best they could. They told her husband they could do no more and if the graft was infected it could not be replaced. Is this true? Is there no possibility of help if they could not remove all the infection? Obviously I am distraught, I love this woman; she is a wonderful person and Mother to her two girls and means everything to her husband. She is in a secondary size hospital, I am wondering if Mayo which is a couple hours from here could help.

It seems there must be something other than let her die that could be done if the graft is infected. The surgeons said there must have been a break in sterility in the OR. I may be niave but I do not remember this happening at U of P when I worked there in the early 80's. Any thoughts would be most welcome, ideas or where to look for help.

Thanks, Bess

[hoolahan, ASN, RN]

{{{{Bess}}} I remember your post a few weeks ago, but I don't think I had anything more to add to it at the time. I have done a lot of cardiac nursing, but not really had any expereince with this type of situation. I can remember only once in my 13 years where I was before, and it was while I was an infection control nurse, that we had a positive culture on a graft.

I had asked my super about it, b/c the culture came from the OR, on a new graft, and I asked why it was cultured in the first place. She told me they send a peice of every new graft for culturing. This one had come back positive, so they were proceeding w ID referral, and most likely to err on the side of caution, the pt would have to receive six weeks of IVAB.

I don't honestly know how to advise you, but I'll tell you this. If it were my family member, and Mayo was that close, we'd be transferring stat!

Call Mayo, ask if you can just bring her in via ambulance for an eval. Get a second opinion. If they tell you there is nothing more to do, then she can return to the first hospital. If they do feel there is better treatment options available, they will probably keep her there and treat her.

I can't speak for cardiac surgeons, but the ortho surgeons I know will not takeover treatment for someone else's surgery. You may have a hard time getting a doc to accept takeover treatment, esp if he susoects there has not been exemplary tx given to your cousin already. That is why I suggest the second opnion route, just get her into the doors, and you may have better results.

I am so sorry you are going through this. Like I said, I don't have much expereince w infected grafts of the aorta, but I have to agree, sometime doesn't add up here, and you should pursue an expert opinion.

[DIPLOMATICRN4HIRE, MSN, RN]

Yes there are times we send a piece of the graft off, but to be very honest we havent done that in years.... it depends on the graft... If it cant be replaced then why??? what is the reasoning???? I would go to Mayo...get another opinion, I would also begin the antibiodic treatments as well... She is in for a long haul ... get the other opinion, get all records... get as much info as you can to help the other Drs with the diagnosis. Beef up your relatives immune system as much as possible. Its a long and difficult process to go through.

Zoe