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PWhitehouse
Blood Cultures from a CVAD

I am looking for clarification on the correct process for drawing blood cultures from a CVAD (only as a last resort, not as a regular practice). INS states that the needleless connector should be removed prior to collection. Some clinicians interpret this to mean that you remove the needleless connector, clean the line with CHG and then do a direct hook-up. Others interpret this to mean you remove the old connector, clean, apply a new connector, clean again, and then draw the culture.

Also, do you innoculate the aerobic or anaerobic culture bottle first? Everything I have read states aerobic due to the possibility of there being a small amount of air in the syringe. Our facility's policy is to collect the anerobic specimen first?

Looking to update some education and policies and want to ensure we are current in our practice.

 

 

 

lynncrni
Regarding the needleless

Regarding the needleless connector, either way is acceptable. So your facility should choose one and write that into your policy and procedure. Research does not indicate a preferred method, however blood cultures should never be drawn from a used needleless connector. 

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

chonna lea
Needle Free connector changes for Blood Culture

Hi- I am a retired clinician from BD.  This has been my talk tract for 14 years.  Per INS, "prior to Blood CULTURE collection" is one of the indications for replacing needleless connectors.  We need to protect the hub of the line as much as possible at all times.   When blood is drawn directly from an open hub it is very likely that blood will enter the threads of the hub and new needleless connector  which offers ideal opprotunity for bacteria.  While INS doesn't clearly state this...based on Germ theory is is best to protect the hub of the device that is intended to remain in place for many days or even months with a needleless connector that can be utilized to draw blood.  The ability to use lines rather than stick patients can have a significant impact on patients experience and satisfaction scores so we don't want to avoid use of the line.

Be sure your connector is indicated for aspiration of bood supported by hemolysis testing.  Do a sterile connector change prior to your blood cultures, make sure your nurses understand that connector change is ONLY for blood cultures and not all blood draws.  Appropriate line flushing is critical as always.

One more thing...Alcohol works on the plastic, CHG works on the skin.  If you use CHG/Alcohol on plastic the CHG doesn't evaporage as quickly and leaves a sticky residue.  Your connectors may get forever stuck on the lines, especially if there are multiple accesses by muliple people over a weeks time-so beware!

Hope this helps!

maggiemae
As a new Vascular Access

As a new Vascular Access Nurse i have seen many people draw labs from peripheral lines.  Does INS support this practice?  Is there any data that states it doesn't increase risk of CRBSI?  With residual blood in the hub I have concerns.

I would also like any referencing to waiting to insert  PICCS with pending blood cultures?  Insert or wait, and if wait, how long?  I have read two studies and it seems to be a non-evidence based practice.

lynncrni
Short peripheral catheters

Short peripheral catheters can be used for drawing blood samples with many studies supporting that the produce reliable lab values. Don't recall any studies on the infection risk but all manipulation of all VADs have risk. See INS Standard on Phlebotomy. 

I have never found any evidence of waiting for any CVAD insertion based on blood cultures. At present the practice in your facility is based on the opinions of your providers. 

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

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