Friday January 19, 2007
Bedside tip !!

Scenario: While performing femoral vein cannulation, you obtained good blood return but after advancing wire you felt resistance so you decide to come out. Wire is bend laterally ! What could be the reason ?

You may have cannulated upper part of great saphenous vein just before it enters femoral vein. As wire may bends while entering the junction and may obstruct free flow of wire. Get new wire and attempt again with little up and lateral with continous palpation of femoral artery to avoid arterial puncture ! (or utilize the bedside ultrasound if available).

Thursday January 18, 2007
Writing orders to check stool for C. diff.


Whenever Clostridium difficile is suspected in a patient, send 2 or 3 samples apart to check for toxins. There are different methods / kits to check for C. diff. toxins in stool and many test kits have lower sensitivity. Sending multiple samples enhance the sensitivity of results.

OR request to run stool for both Toxin A and B of clostridium difficile.

If stool test continue to remains negative despite high clinical suspicion, ask specifically for culture of Clostridium difficile. The organism does not grow on standard media and thus the laboratory must be informed that Clostridium difficile is suspected.

Remember ! Alcohol doen't kill C.diff. spores so washing with soap and water should be done after examining patient with C. Diff.



Related previous pearls:

Stool donation as C. Diff treatment

Fluoroquinolone induce strain of C. Diff.