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Acute lymphoblastic leukemia

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Case Study
A 24-year-old man presents to the emergency department complaining of a fever with shaking chills for the past 12 hours. He is currently being treated for acute lymphoblastic leukemia. His most recent chemotherapy session with cycloposphamide, vincristine doxorubicin and dexamethasone was 7 days ago. He denies any cough or dyspnea, headache, abdominal pain, or diarrhea. He has had no sick contacts or recent travel. On physical examination, he is febrile to 103 °F and a heart rate of 122 beats per minute (bpm). His blood pressure is 118/65 mm Hg, and respiratory rate is 22 breaths per minute. He is ill appearing; his skin is warm and moist but without any rashes. His chest is clear to auscultation. His heart rate is regular with a soft systolic murmur at the left sternal border. The abdominal examination is benign. The perirectal area is normal. The digital rectal examination is deferred, and his stool is negative for occult blood. He has a tunneled vascular catheter at the right internal jugular vein without erythema overlying the subcutaneous tract or purulent discharge at the catheter exit site. He states he flushes the catheter each day and that yesterday he experienced a 20- to 30-minute episode of shaking chills about 10 minutes after flushing the catheter. Laboratory studies reveal a total white blood cell (WBC) count of 1100 cells/mm3, with a differential of 10% neutrophils, 16% band forms, 70% lymphocytes, and 4% monocytes (absolute neutrophil count [ANC] 286/mm3). Chest radiograph and urinalysis exams are normal.
Case analysis
1) What is the most likely diagnosis?
2) What are your next therapeutic steps?
Clinical Question
To reduce the prevention of intravascular catheter-related infections, there are many measures in place by guidelines. Review minimum two articles and summarize your conclusion-1 page of A4.
Choose one question (you can do more than one if you want)
-Types of Catheters
-Skin preparation
-insertion site (example: aline vs. central line, -femoral/IJ/subclavian extra)
-# of lumen and infection risk
-systemic antibiotic prophylaxis
Please make sure you compare/summarize with the most current (national) guideline and your upto date article (study/evidence)
Make your own conclusion
submit your article(s)

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