Significant pulmonary embolization was not observed. All vessels exhibited endothelial denudation that occasionally extended into the internal elastic lamina while no injury extended to the media. In a canine DVT model, the Oasis catheter has an 80% procedural success rate. The presence of the dedicated wire lumen also avoids a reduction in suction through the exhaust lumen that can be observed with the ATS device. In contrast to the ATS system, which requires a separate drive unit, the Oasis can be powered by a standard power injector. The Oasis catheter (Boston Scientific, Natick, MA), originally marketed as the Shredding Embolectomy Thrombectomy catheter, is a triple-lumen catheter placed over a guidewire that allows for the infusion of saline and simultaneous aspiration of thrombus. Ultimately, surgical or endoscopic removal of the mass of fungal organisms is essential to eradicate the organism.ĬOLLEEN M. 12 Absorption of amphotericin does not occur, and direct infusion is not nephrotoxic.

In the setting of obstruction due to a fungus ball, irrigation through a percutaneous nephrostomy tube with amphotericin is recommended in addition to systemic antifungal therapy with fluconazole. glabrata, which are resistant to fluconazole and flucytosine. 12,16 The one exception might be lower tract infection with C. Recent literature suggests that amphotericin bladder irrigation is a strategy rarely needed given the need for catheter placement and the availability of more convenient treatment options, and this method of treatment is not recommended.

It is likely that irrigation eliminates bladder colonization in the short term, but it is not evident that bladder infection can be treated with this maneuver. 15 However, the effect is brief, and recolonization occurs within 1 to 2 weeks. Bladder irrigation will clear candiduria more quickly than systemic antifungal agents will. Kauffman, in Comprehensive Clinical Nephrology (Fourth Edition), 2010 Local Antifungal AdministrationĬontinuous bladder infusion of amphotericin, 50 mg in 1 liter of sterile water with a triple-lumen catheter, is sometimes used to treat Candida bladder infection. Despite the conflicting evidence, triple-lumen catheters have the advantage of offering what otherwise would require three independent, single-lumen catheters.Ĭarol A.

Studies of the infectious risk of multilumen catheters have yielded conflicting results, probably because of the failure to control for the sicker baseline state of the patients in whom triple-lumen catheters are used. 104 who classified patients according to severity of illness using the APACHE score. However, increased rates of infection were not recognized by Gil et al.

Reasons for the possible increased risk of infection remain unclear, although they may be related to increased catheter size with concomitant tissue and vascular trauma and more manipulations. There was a marked difference between the two groups: 8% of patients with single-lumen catheters developed catheter-related infection as opposed to 32% of patients with triple-lumen catheters (mean duration of insertion 6.01 and 4.76 days, respectively). 119 prospectively studied 502 catheters (126 single-lumen catheters and 93 triple-lumen catheters) in 362 patients. 177 found similar rates and concluded that triple-lumen catheters should not be used for long-term parenteral nutrition. The rate of catheter-related infection was 3.5% in the former group and 15% in the latter group. 205 prospectively studied the sepsis rate of single-lumen versus triple-lumen catheters in patients receiving parenteral nutrition. Matlow, in Pediatric Critical Care (Third Edition), 2006 Multilumen Central Venous Lines.

Triple lumen central line