Description of Event or Problem · 1
A (B)(6) YEAR OLD MAN WITH A WISKOTT-ALDRICH SYNDROME, MEDIASTINAL LARGE CELL LYMPHOMA (DIAGNOSIS A YEAR AGO OF S/P CHEMOTHERAPY (R-CHOP, RICE), RADIOTHERAPY (XRT) AND DOUBLE UNRELATED CORD BONE MARROW TRANSPLANT (DUCBT) ABOUT SEVEN MONTHS PRIOR TO EVENT, IGA NEPHROPATHY, (B)(6) CHRONIC KIDNEY DISEASE (CKD), ATYPICAL MYCOBACTERIAL INFECTION OF ANKLE DIAGNOSED ABOUT FIVE MONTHS PRIOR TO EVENT, AND (B)(6) INFECTION, WITH A DIFFUSE RASH GRAFT-VERSUS-HOST-DISEASE (GVHD) AND FEVERS, WITH EVOLVING PULMONARY INFILTRATES. ADMITTED ABOUT TWO WEEKS PRIOR TO EVENT, PICC PLACED. BECAME FEBRILE, PICC REMOVED AND THIS LEFT INTERNAL JUGULAR (LIJ) 6F BARD POWERLINE PLACED TEN DAYS AFTER FIRST PICC PLACED. BIOPATCH USED PER ROUTINE WITH DRESSING CHANGES. THIS PATIENT WAS REQUIRING EVERY OTHER DAY (QOD) DRESSING CHANGES BECAUSE OF SEROSANGUINOUS DRAINAGE AT LINE SITE. EIGHT DAYS AFTER LIJ PICC PLACEMENT, THE DRESSING WAS CHANGED AND THE BIOPATCH WAS NOT USED BECAUSE THE PATIENT'S SKIN LOOKED EXCORIATED AND PT. DESCRIBED "BURNING". WHEN THE DRESSING WAS NEXT CHANGED, THE SITE APPEARED NORMAL AND BIOPATCH WAS PUT BACK ON (CONCERN FOR INFECTION IN VERY IMMUNOCOMPROMISED PATIENT). FOURTEEN DAYS AFTER LIJ PICC PLACEMENT, WHEN LINE DRESSING WAS TAKEN DOWN TO CHANGE THE SITE WAS DRAINING GREEN AND YELLOW. THE SITE WAS CLEANED BUT IT WAS STILL DRAINING. PLASTIC SURGERY WAS CONSULTED AND NOTED THAT GREEN/YELLOW EXUDATE IS ESCHAR CONSISTENT WITH DEEP SECOND/THIRD DEGREE BURN WOUND. BIOPATCH REMOVED/KEPT OFF AND SITE MONITORED. SITE DID NOT IMPROVE, THEREFORE LINE CHANGED TO NEW LOCATION. IT'S OUR BELIEF, BASED ON SEVERAL OBSERVED CASES NOW, THAT PATIENTS WITH CERTAIN SKIN SLOUGHING CONDITIONS ARE AT A HIGH RISK FOR A REACTION CONSISTENT WITH A CHEMICAL BURN ASSOCIATED WITH THE USE OF THE BIOPATCH DEVICE.