when we suspect a CRBSI, peripheral and central lines blood cultures are drawn the same time and label 'time to positivity' on the lab slips.
However, when a patient is difficult stick, sometimes staffs are not able to obtain peripheral culture.
How do you rule out/rule in a CRBSI if there is only on positive blood culture from a central line (but no peripheral culture available)?
Whether you are using differential time to positivity, or quantitative cultures, it requires a comparison of blood drawn from all lumens of the line, and a peripheral set. This is what we struggled with for years prior to initiating our protocol for paired cultures. The answer is that you just don't have enough information to come to a conclusion. In those cases, I would suggest that if you can, have someone use ultrasound to tap a vein and get that peripheral sample.
Jerry Bartholomew RN, BSN, CRNI
VA Medical Center, Spokane, WA
Jerry Bartholomew RN, MSN, CRNI
VA Medical Center, Spokane, WA
Robbin George RN VA-BC
This is policy in our facility. It is unlikely that all lumens will be contaminated, so unless you culture all of them, you may miss the contaminated lumen. This would lead you to diagnose a primary blood stream infection rather than a catheter related blood stream infection.
The optimal culture sample in our facility is 10 ml, which can add up quickly. The opinion from our lab is that the likelihood of an anaerobic culture being positive is extremely low, so they draw an aerobic and anaerobic culture from the peripheral site, and we draw an aerobic culture from each lumen.
Jerry Bartholomew RN, BSN, CRNI
VA Medical Center, Spokane, WA
Jerry Bartholomew RN, MSN, CRNI
VA Medical Center, Spokane, WA