I have been teaching that a direct connect to a central line with a vacutainer and a blood culture bottle should be avoided due to possible cross contamination and the medium can be deadly. This is stated in Guidelines for Critical Care. Does anyone know of any other resource?
Chris Thomas
I was recently asked to help with a systematic lit review on all aspects of blood cultures and this issue was not found in the literature. What is the source from the critical care document. I am also trying to envision the physical connection being made and having trouble understanding how this connection would be made so that there would be a chance of the medium entering the bloodstream. Is that what you are saying? Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
I am retired but doing some local teaching so I have to reach out to my former colleagues on this.
I may be able to get this information for you. When this was first addressed, it was 2010. I am getting the educator to send me the specific quote from the Critical care source and asked her to also check to see if that statement has any resources.
Also, another educator is bringing me an actual culture bottle that states this as a precaution. So I will get back to you on this.
Although very remote, if a nurse were to attach a bottle to the special blood culture vacutainers, if she held it upside down where the fluid is by the outlet, the unlikely chance that the bottle was flawed and suction not present, once attached to a central line, I could envision a patient taking a deep breath and the fluid would inadvertently go into the tubing. If flushed, then that would send that substance into the patient.
I agree, very bizzare, but a chance. We always teach to keep bottles upright with fluid at the bottom.
Anyways, will get back to you on sources.
Thanks,
Chris
some time around 2003 I remember a change in our procedure for drawing cultures from a central line. At the time we were using the bottles that had narrow necks to fit into the vacutainers. The educator explained the system allowed for proteins from the culture bottles to get into the line and thus into the patient's circulation. It was too long ago to remember specific products etc. I would hope that problem would be distant history by now.
The only culture bottles I have ever seen are 30 mL bottles with a regular rubber stopper in the top. They would not fit into a vacutainer holder. I would look at the label as I would bet that there is nothing stating that this media can be given IV. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Hi Lynn,
The only blood culture bottles I have ever seen are ones that fit into vacutainers. If the bottles don't fit into the vacutainers, then how does the lab tech draw them when performing peripheral sticks?
Juline DiSilvestro BSN, RN, CRNI, VA-BC, CPUI
Central Access Team Nurse
Inspira Medical Center- Woodbury,NJ
With a syringe attached to the butterfly and then transferred to the culture bottle AFTER scrubbing the stopper of the bottle. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
I think most facilities are aiming to not have staff sticking a needle into bottles or tubes. We also have syringe transfer adapters now for the safe transfer of blood or fluid. The needleless syringe of blood attaches to one end, and the other end is a vacutainer for the lab tubes or bottles to be inserted. I am not sure if all facilities have them though.
Juline DiSilvestro BSN, RN, CRNI, VA-BC, CPUI
Central Access Team Nurse
Inspira Medical Center- Woodbury,NJ
Yes, you are correct on the needle issue. I have never seen a diffierent configuration on the bottles or the vacuum tube holder to fit the short wide bottles. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
the blood culture bottles I was talking about were shaped like the Bactec bottles
The bottles fit into the vacutainer while attached to the VAD. Apparently there were incidences of the medium getting into circulation.
Thanks for the picture. Never seen those before. I would think there is some warning on the label about getting the medium into the vein. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Smiths-Medical has a vacutainer blood culture adaptor to fit the now smaller and stout blood culture tubes. See http://www.smiths-medical.com/upload/products/mainImages/saf-t-holders.png.
I did receive a reply from the manfacturers that make the BacT alert culture bottles along with the MSDS and package insert.
They do recommend that blood for the cultures should be drawn as a direct draw inoculation with the use of a butterfly collection set and draw from the central line with syringe and use the adaptor cap.
While the substance in the culture medium is not made of any toxic substances per the MSDS, there is a warning that the substance is not sterile and if medium is inadvertently pulled back to lumen and subsequently injected, this would be
considered contamination of the line.
"This product contains products of animal origin. Certified knowledge of the origin and/or sanitary state of the animals does not totally guarantee the absence of transmissible pathogenic agents. It is therefore recommended that these products be treated as potentially infectious and handled observing the usual safety precautions."