Norrie, I have been doing research because I am working on sepsis protocols and found the following:
Frey, Anne M., Drawing Blood Samples From Vascular Access Devices. Journal of Infusion Nursing, Vol. 26, No. 5, Sept/Oct 2003. Pg 285-293.
Ryder, Marcia A., Catheter-Related Infections: It's All About Biofilm. Topics in Advanced Practice Nursing eJournal. 2005. Vol. 5, No. 3, August 2005.
Beutz, Michelle, et. al., Clinical Utility of Blood Cultures Drawn From Central Vein Catheters and Peripheral Venipuncture in Critically Ill Medical Patients. Chest 2003. Vol 123. Pg. 854-861.
McBryde. E. S., Tilse, M., McCormack, J., Comparison of contamination rates of catheter-drawn and peripheral blood cultures. Journal of Hospital Infection (2005). Vol 60. February 2005. Pg. 118-121.
Mimoz, Olivier, et al., Chlorhexidine Compared with Povidone-Iodine as Skin Preparation before Blood Culture. Ann Intern Med. 1999. Vol 131. Pg. 834-837.
Trautner, Barbara W., Clarridge, Jill E., Darouiche, Rabih, Skin Antisepsis kits containing alcohol and chlorhexidine gluconate or Tincture of Iodine are associated with low rates of blood culture contamination. Infection Control and Hospital Epidemiology. Vol 23, No. 7. Jul 2002. Pg. 397-401
Calfee, David, and Farr, Barry, Comparison of Cour Antiseptic Preparations for Skin in the Prevention of Contamination of Percutaneously Drawn Blood Cultures: a Ramdomized Trial. Journal of Clinical Microbiology, Vol 40, No. 5. May 2002. Pg. 1660-1665.
A recent reference which provides a good overview of CRBSI's:
Raad, I & Maki, D. Intravascular-catheter related infections: advances in diagnosis, prevention and management. Lancet Infect Disease. 2007; Oct; 10(7): 645-657
In 2008 when the CMS regs are put into effect how are we going to determine if an existing CVC is harboring an infection prior to admitting a patient to the Hospital--Is there a standardized universal technique for culturing a catheter in situ? And if such a method exists please explain the method or a reference for the method--Thank You
Great question and one I am very interested in knowing. There is no single universal culturing technique. There are 2 methods for enhancing the clinical diagnosis of CRBSI. You draw blood cultures from the catheter and a peripheral site at the same time. If the catheter sample grows more than 5 times the number of colony-forming units, the catheter is implicated as the source. You can also use time to positivity - the sample from the catheter becomes positive 2 hours before the sample from the peripheral vein.
But there is much discussion now about the validity of all traditional culturing techniques. The only way a sample will be positive is if you happen to capture planktonic (free-floating) microorganisms in the blood sample sent to the lab. The more blood you send, the greater the ability to actually culture something.
So I am very curious to know what others are doing about this actual diagnosis. Lynn
Norrie, I have been doing research because I am working on sepsis protocols and found the following:
Frey, Anne M., Drawing Blood Samples From Vascular Access Devices. Journal of Infusion Nursing, Vol. 26, No. 5, Sept/Oct 2003. Pg 285-293.
Ryder, Marcia A., Catheter-Related Infections: It's All About Biofilm. Topics in Advanced Practice Nursing eJournal. 2005. Vol. 5, No. 3, August 2005.
Beutz, Michelle, et. al., Clinical Utility of Blood Cultures Drawn From Central Vein Catheters and Peripheral Venipuncture in Critically Ill Medical Patients. Chest 2003. Vol 123. Pg. 854-861.
McBryde. E. S., Tilse, M., McCormack, J., Comparison of contamination rates of catheter-drawn and peripheral blood cultures. Journal of Hospital Infection (2005). Vol 60. February 2005. Pg. 118-121.
Mimoz, Olivier, et al., Chlorhexidine Compared with Povidone-Iodine as Skin Preparation before Blood Culture. Ann Intern Med. 1999. Vol 131. Pg. 834-837.
Trautner, Barbara W., Clarridge, Jill E., Darouiche, Rabih, Skin Antisepsis kits containing alcohol and chlorhexidine gluconate or Tincture of Iodine are associated with low rates of blood culture contamination. Infection Control and Hospital Epidemiology. Vol 23, No. 7. Jul 2002. Pg. 397-401
Calfee, David, and Farr, Barry, Comparison of Cour Antiseptic Preparations for Skin in the Prevention of Contamination of Percutaneously Drawn Blood Cultures: a Ramdomized Trial. Journal of Clinical Microbiology, Vol 40, No. 5. May 2002. Pg. 1660-1665.
Hope this helps you get started.
Carole Fuseck
Calfee and Farr: Comparison of FOUR (not Cour) sorry.
Carole
A recent reference which provides a good overview of CRBSI's:
Raad, I & Maki, D. Intravascular-catheter related infections: advances in diagnosis, prevention and management. Lancet Infect Disease. 2007; Oct; 10(7): 645-657
Daphne
Daphne Broadhurst
Desjardins Pharmacy
Ottawa, Canada
Robbin George RN VA-BC
Great question and one I am very interested in knowing. There is no single universal culturing technique. There are 2 methods for enhancing the clinical diagnosis of CRBSI. You draw blood cultures from the catheter and a peripheral site at the same time. If the catheter sample grows more than 5 times the number of colony-forming units, the catheter is implicated as the source. You can also use time to positivity - the sample from the catheter becomes positive 2 hours before the sample from the peripheral vein.
But there is much discussion now about the validity of all traditional culturing techniques. The only way a sample will be positive is if you happen to capture planktonic (free-floating) microorganisms in the blood sample sent to the lab. The more blood you send, the greater the ability to actually culture something.
So I am very curious to know what others are doing about this actual diagnosis. Lynn
Lynn Hadaway, M.Ed., RN, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861