I think the evidence directs us to obtain cultures from each lumen and a peripheral set to either determine whether the infection is line associated. An interesting article with plenty of references is "CLINICAL JOURNAL OF ONCOLOGY NURSING • VOLUME 6, NUMBER 5 • DEVELOPING A PROTOCOL FOR OBTAINING BLOOD CULTURES" published in 2002
When drawing from a CVA should there be a 5cc waste or should you just draw the alloted amount for each bottle and place it in the bottles. I was under the impression that you always have to do a waste before collecting any specimen from a central line access but a traveling RN related that she was told to draw no waste when collecting from a central line for blood cultures. She stated that in drawing the waste, you have less of a possibility of obtaining any problem from the line. I don't believe that this is true but I would love to hear from others on this topic. I believe that if the line is infected, then any specimen that you obtain from the line will reflect this.
I discussed with our head microbiologist recently and her thoughts were as follows: If you use the "discard" blood from the line, it reflects the line colonization but not necessarily the blood stream growth. If you draw and waste discard, then draw blood culture specimen, it is more reflective of blood stream. All lumens should be cultured, even though you would think that if one was positive, the other[s] would be, but that is not always the case. Interesting topic and there were recently new guidelines published on this site regarding blood cultures, but I forget the source.
AM
Anne Marie Frey RN, BSN, CRNI
Clinical Nurse Level Four
Vascular Access Service: I.V. Team
The Children's Hospital of Philadelphia
Anne Marie Frey RN, BSN, CRNI, VA-BC Clinical Expert Vascular Access Service: I.V. Team The Children's Hospital of Philadelphia [email protected]
The ID DR that I used to work with wanted the first draw put into the culture bottles without any waste. He felt there was a better chance of getting more bacteria an hopefully they would grow. He didn't want the bacteria count diluted at all by flushing them into the blood stream. This is what I always have done. I know there are differing opinions. We just changed our procedure here at my new place of employment. If the line is suspected of being infected it is pulled and the tip cultured. All Blood cultures are drawn pereipherally. I didn't say that I agree with this at all.
i worked peds hem/onc for quite a while and we always used the first blood from each lumen. if they grew anything we did daily cultures until they were negative.
Blood Cultures from a CVA
When drawing from a CVA should there be a 5cc waste or should you just draw the alloted amount for each bottle and place it in the bottles. I was under the impression that you always have to do a waste before collecting any specimen from a central line access but a traveling RN related that she was told to draw no waste when collecting from a central line for blood cultures. She stated that in drawing the waste, you have less of a possibility of obtaining any problem from the line. I don't believe that this is true but I would love to hear from others on this topic. I believe that if the line is infected, then any specimen that you obtain from the line will reflect this.
I discussed with our head microbiologist recently and her thoughts were as follows: If you use the "discard" blood from the line, it reflects the line colonization but not necessarily the blood stream growth. If you draw and waste discard, then draw blood culture specimen, it is more reflective of blood stream. All lumens should be cultured, even though you would think that if one was positive, the other[s] would be, but that is not always the case. Interesting topic and there were recently new guidelines published on this site regarding blood cultures, but I forget the source.
AM
Anne Marie Frey RN, BSN, CRNI
Clinical Nurse Level Four
Vascular Access Service: I.V. Team
The Children's Hospital of Philadelphia
Anne Marie Frey RN, BSN, CRNI, VA-BC Clinical Expert Vascular Access Service: I.V. Team The Children's Hospital of Philadelphia [email protected]
Kathryn Kennard, CRNI
McKenna, WA
The ID DR that I used to work with wanted the first draw put into the culture bottles without any waste. He felt there was a better chance of getting more bacteria an hopefully they would grow. He didn't want the bacteria count diluted at all by flushing them into the blood stream. This is what I always have done. I know there are differing opinions. We just changed our procedure here at my new place of employment. If the line is suspected of being infected it is pulled and the tip cultured. All Blood cultures are drawn pereipherally. I didn't say that I agree with this at all.
Kathryn Kennard, CRNI
McKenna, WA