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Nancy Safranek
Blood cultures from central lines
Looking for evidence-based practice for cleaning caps or otherwise preparing central lines for blood withdrawal for blood cultures. CL are not the only source for the blood cultures but are drawn as possible evidence of CRBI. Our current blood culture policy was written by lab and makes no reference to central access for blood cultures. Thanks, Nancy
lynncrni
There is only one study that

There is only one study that has tested the agent and process for disinfection of needleless connectors. This was a bench study inoculating various connectors then cleaning them for 15 secs with both CHG/IPA or IPA alone. Both were sufficient to remove the organisms. There have been no studies looking specifically at cleaning these connectors in preparation for drawing blood cultures. Since we know that these connectors can become contaminated, I would recommend they be removed and that the blood sample be obtained directly from the catheter hub. 

Lynn Hadaway, M.Ed., RN, BC, CRNI

www.hadawayassociates.com

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

plsysinc
I disagree with Lynn about

I disagree with Lynn about removing the cap.  While there may not be any studies directly related to this there are studies discussing stopcocks using a direct connection or through a connector Oto J et al and Casey AL et al that show through the connector is related to less intraluminal contamination.  In addition many hospitals are using a product called BacT/alert which allows closed system blood culture draws.  Obviously, thorough scrubs are important.  And while we have one for 15 seconds we do not have any that show lower end and higher end ranges for scrubbing nor do we have anything that discusses methods i.e scrubbing like squeezing an orange.  Sophie Harnage reports using this squeezing the orange approach with PICCs and is still at zero CRBSI to report after 25 months and actually is at 35 months and over 6000 PICCs.  I believe while extrapolating the data is required that her method must be working even though it is described in a bundle environment.  While her study is case study descriptive format - this observational research is strong if the results are maintained over time.  3 years seems to meet that standard.  They do draw labs through the connector.  In Sophie's program it is not only the septum disinfection but the type of connector that is impacting results.  So proper technique plus intraluminal protection system permit safe sampling

Denise Macklin

Anne Marie Frey
there was a poster at May

there was a poster at May INS in Phoenix that talked about cap removal or not for blood cultures and I don't recall the conclusion, but would like some input from that author if possible and am trying to locate her via INS.

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]

Michele Anderson
Michele

Michele Anderson,RN,BSN   

Review an article by Marcia Ryder,PhD, "Catheter-Related Infections: It's All About Biofilm." To view article online see: http://www.medscape.com/viewarticle/508109. She refers to the yet lack of evidence in the decision to discard or submit the first drawn sample from a central venous catheter and does not mention removal of the injection cap/connector.  Cleansing/scrubbing the site whether skin or injection cap with chlorhexidine and allowing it to dry thoroughly would be an appropriate method of disinfection for blood culutres. It would seem reasonable to do a line culture through the injection cap since if the cap is laden with bacteria...the internal catheter lumen is also contaminated with same.

Michele Anderson,RN,BSN

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