Pulmonology help

[monet]

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I have a patient that has tuburculosis. She has been in the hosp 15 days. She has no fever, cough, ect. However she is still testing positive for TB. How often can I do a sputum test? I know we need three negatives in a row. Also, when can she go home?

 

[starayamoskva]

I have a patient that has tuburculosis. She has been in the hosp 15 days. She has no fever, cough, ect. However she is still testing positive for TB. How often can I do a sputum test? I know we need three negatives in a row. Also, when can she go home?

Is she being discharged to an institution like a nursing home? If she is having no symptoms and isn't being discharged to an institution there should be no reason why she can't go home. She will of course require close follow up and depending on your state's regulations will be required to take her medicines.
The state may also dictate when a person can be discharged in regards to testing negative.

 

[MustafaMond]

BTW- How did that thing with the cheating go?

 

[Harrie]

I have a patient that has tuburculosis. She has been in the hosp 15 days. She has no fever, cough, ect. However she is still testing positive for TB. How often can I do a sputum test? I know we need three negatives in a row. Also, when can she go home?

Order sputums every morning. Once she has three in a row that are negative, its a la casa!

 

[Doc Ivy]

Order sputums every morning. Once she has three in a row that are negative, its a la casa!

I think the issue is that the patient isn't coughing and thus collecting sputum is proving difficult... but hey maybe I'm wrong

 

[starayamoskva]

I think the issue is that the patient isn't coughing and thus collecting sputum is proving difficult... but hey maybe I'm wrong

That is easy to fix just have the respiratory therapist snake her.

 

[Mumpu]

Erm, so how do you know that she has TB if you can't get cultures? Is this based on PPD?

A positive PPD test does not mean active TB, only that there was exposure at some point. People who have had the BCG vaccine will also have a positive PPD test.

 

[Doc Ivy]

That is easy to fix just have the respiratory therapist snake her.

thanks for the info 👍

 

[Jaded Soul]

Order sputums every morning. Once she has three in a row that are negative, its a la casa!

Yup, this is medically acceptible. However, check with epidemiology/TB control at your hospital because they most likely have stringent protocols for d/c'ing TB patients back to the community.

Getting sputum induction can be a pain. It's probably just my hospital, but I've had patients wait for WEEKS in house for induction. There is only one RT who does it, he doesn't work everyday, and he takes his sweet time doing his job.

 

[Bobblehead]

To properly answer this question you need to really give more information. You state the patient has Tb. Is this a strong clinical suspicion, PPD, smear positive, or culture positive diagnosis. Is continuing to test positive a continued positive PPD reaction, continued smear positivity, continued culture positivity or just clinical symptoms.

In general you can do three induced sputums on consecutive days either with hypertonic or normal saline or even just albuterol. These usually have to be done in some type of negative pressure environment because the assumption is you're aerosolizing a lot of AFB.

However, even having three negative sputum samples will not preclude a patient where your index of suspicion is high from undergoing bronchoscopy for lavage. And even if that is negative the patient if the index of suspicion is high enough will likely end up undergoing 4 drug therapy until the cultures come back negative.

Regarding the patient being contagious, if they're not coughing and coughing up a lot of AFB they may be infected but not infectious unless you're doing something to provoke them but even that is unlikely unless they have an abnormal CXR.

That's the "short" answer. It gets a bit more complicated too..