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Kevin Travis Flint
Blood Cultures Obtained from PICC Line

How many facilities do not draw blood cultures from picc lines?  We have a slew of MD's that order one bottle from picc and one from peripheral site, however a universtiy MD considered an infection control guru says no cultures should be drawn from the picc.  In thinking about this and by drawing from the picc could it be possible the rate of CVC infections is scewed, or do you think if the CVC has an infection, the pateint must have an infection?

 

Kevin

lynncrni
Are you trying to rule out

Are you trying to rule out the catheter as the source of a BSI? If so, then you must draw a blood sample for culture from the catheter and a peripheral site and compare those 2 results with either time to positivity or colony counts. I think your physician is incorrect and outside the thinking of other nationally known infectious disease experts. You should find and read this:

1.    Mermel L, Farr B, Sherertz R, et al. Guidelines for the management of intravascular catheter-related infections. Journal of Infusion Nursing. 2001;24(3):180-205.
 

 

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

www.hadawayassociates.com

Lynn Hadaway, M.Ed., NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

Kevin Travis Flint
Lynn do you consider a
Lynn do you consider a positive cx of a central line  = CBSI?
lynncrni
Time to positivity looks at

Time to positivity looks at the length of time required for each sample to become positive. Sample from the CVC must become positive at least 2 hours prior to the peripheral sample for the line to be consider the source. Colony counts must be at least 5X more from the CVC sample than the peripheral sample.

 

CDC guidelines are written for prevention and do not address management of line infections. That is why I gave you the reference from the Infectious Disease Society of America for their management guidelines.  

 

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

www.hadawayassociates.com

Lynn Hadaway, M.Ed., NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

rivka livni
After many discussios and

After many discussios and unnecessary removals of PICC lines, our institurion developed the Policy set by ID / IC : NO blood culture from venous catheters.

Since some of the catheters are many months old, the hubs may be contaminated and since you must attach the syringe onto the hub to draw the blood culture, whatever grows on to the hub will grow in the blood culture bottle.

Our policy now for suspected infection, do two peripheral blood cultures, if they are positive the line will be removed, then we send the tip for culture too (only if two blood cultures are positive).

 

anna liang
we use time to positivity to

we use time to positivity to r/o or r/i CRBSI. we no longer do tip culture. it is interesting that facilities use different methods to define CRBSI. (do you think the CRBSI rates change once the defining methods change?)

if peripheral cultures are negative, but line cultures positive (usually >2 days), we pull the line -- line infection but no CRBSI. 

Kevin Travis Flint
Shouldn't everyone be using
Shouldn't everyone be using the CDC guidelines?
lynncrni
Yes, for prevention of

Yes, for prevention of infection but they do not address management of infection.  

 

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

www.hadawayassociates.com

Lynn Hadaway, M.Ed., NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

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