At our hospital we are working on a policy for obtaining blood cultures from Piccs and Central Lines. I would appreciate any input out there as to "Best Practice and Procedure" and if any, what is your policy in your institution? Do you remove caps? Do you waste ? etc., etc. Much thanks for your feedback.
Maureen Amirhekmat rn,crni
The recommendation from the lab people (I can't remember their name now..CLSI?), the recommendation is for the peripheral lab draws for blood cultures, not from the CVC. Only CVC blood cultures, if specified by physician's order specifies a blood culture to be done via a CVC. This is what our policy is based on.
This is not answering your question specifically, but if you want references for blood cultures, it has to be more about the evidence for getting the best results for bloodstream infections related to CVC and not about the other variables, such as removing caps and wasting.
Gwen Irwin
Austin, Texas
The way I understand it, if you want to check the line for infection, you don't waste and you would want to have 2 peripheral sticks to go along with it to check for blood stream infection. If you want to check for a blood stream infection from the line, you do waste. For either, we would change the cap prior to the draw. The CDC says we should have 2-3 peripheral cultures and the Docs usually want us to check the PICCs on top of that by not wasting. But for purposes of infection monitoring and reporting, only the blood stream infection would be counted. For the purposes of the physician, the PICC may be a potential source and they may want a new one placed if it came back positive and the peripheral sticks were negative, but systemic antibiotics would not be used if there was not a blood stream infection. Please anyone respond to this if you understand differently because I am trying to get this correct for our policy as well.
Michelle Todd, CRNI--Head PICC Nurse, Vibra Specialty Hospital of Portland [email protected]