Patients with chronic
indwelling venous
access lines
(e.g., Hickman). |
AHA prophylactic antibiotic recommendations (low risk). |
There is no clear scientific proof detailing infectious risk for these lines
following dental
procedures. This
recommendation is
empiric. |
Neutrophils
|
|
Order CBC with
differential. |
>2,000/mm3 |
No prophylactic antibiotics. |
|
1,000–2,000/mm3 |
AHA prophylactic antibiotic
recommendations (low risk). |
Clinical judgment is critical. If infection is present or
unclear, more
aggressive antibiotic
therapy may be
indicated. |
<1,000/mm3 |
Amikacin 150 mg/m2 1 hour
before surgery; ticarcillin
75 mg/kg IV ½ hour before
surgery.
Repeat both 6 hours
postoperatively.
|
If organisms are known or suspected, appropriate adjustments should be made based on sensitivities. |
Platelets*
|
|
Order platelet count
and coagulation tests. |
>75,000/mm3 |
No additional support needed. |
|
40,000–75,000/mm3 |
Platelet transfusions are
optional; consider
administering preoperatively
and 24 hours later. Additional
transfusions are based on
clinical course. |
Utilize techniques to promote establishing and maintaining control of bleeding (i.e., sutures, pressure packs, minimize trauma). |
<40,000/mm3 |
Platelets should be transfused
1 hour before procedure, immediately obtain
platelet count, transfuse
regularly to maintain counts
above 30,000–40,000/mm3 until
initial healing has occurred. |
In addition to above, consider using hemostatic agents (i.e., microfibrillar collagen, topical thrombin).
Monitor sites
carefully.
|