First, you should understand definitions. CLABSI is a term used for surveillance with specific criteria established by CDC and it is know to over-estimate the number of infections. CRBSI is a diagnostic definition used when there is a need to actually diagnose and treat a patient. See CDC guidelines for a discussion of these differences. See 
Clinical Practice Guidelines for the Diagnosis and Management of Intravascular Catheter-Related Infection: 2009 Update by the Infectious Diseases Society of America
for information about blood cultures to make this diagnosis. 

There are 2 studies showing that blood cultures should not be drawn through any used needleless connector due to the false positive results. This is discussed in the INS Standards from 2011. 

Lynn

I think what you are asking is is there evidence that show an increase in bloodstream infections in central lines that have blood samples taken from them routinely.  I do know that the more often we enter the system, and manipulate the hub, the greater the risk of contamination of the hub and subsequent infection.  There is a long list of references in the INS Standards under Standard 27, Needleless Connectors.  You can try looking at some of those for evidence.

Personally, I would prefer that lines never be used for blood sampling unless there is no peripheral site to draw from, the patient is needle-phobic or pediatric, or the patient (having been educated about the risks and benefits of using the line) requests it.

What about vein sparing?  Many of the patients who have a picc line are very sick or have been in and out of the system a lot with multiple IV's and lab sticks etc.. leaving very little good veins to choose from.  I have patients that get multiple sticks by lab because they cannot get a decent vein to draw from them we end up drawing from the central line anyway.  I understand less hub manipulation but feel it is a catch 22 sometimes.  I know good clinical judgement is the key however I am the only Vascular nurse in our facility and not here 24/7 therefore just venting frustrations.

I did say to use the line if there is no peripheral site to draw from.  I just think we should try to decrease hub manipulation and blood draws based on their frequency are major hub manipulators.

 I agree with Wendy. The goal is to reduce cath hub manipulation as much as possible. This requires a risk vs benefit assessment for each patient. Using any catheter for blood drawing should never be a situation where you always used them or you never use them. Each patient is different, however we do need to get away from using any VAD for this as much as possible. Lynn

Rates of infection for single-lumen versus multilumen central

atheter-related bloodstreaminfection (CRBSI) occurs commonly (1) in the United States, with a prevalence ranging from 3% to 7% (2–5). The attributable mortality of CRBSI is approximately 15%, and each episode is estimated to cost approximately $9,000 (2). Catheter colonization— or bacterial growth from the catheter tip without bacteremia— occurs in 20% of central venouscatheters (2, 6, 7), with an estimatedcost of almost $400 per episode(2). Despite these infectious complications,central venous catheters remain essential in the treatment of many hospitalizedpatients, especially the criticallyill. Identifying modifiable risk factors forcatheter-related infection is thereforecrucial. The use of multilumen central venouscatheters provides obvious advantages inpatients who may require numerous intravenousmedications, laboratory tests,blood product  ransfusions, and parenteralnutrition. Since their introductiontwo decades ago, triple-lumen cathetershave become the preferred central venouscatheters for patients requiring centralvenous access (6). Unfortunately, multilumen central venous catheters may lead to a higher rate of catheter colonization and CRBSI because of a higher  requency of catheter manipulations, with subsequent bacterial introduction; however, clinical trials directly comparing rates of CRBSI and catheter colonization between single- and multilumen catheters have yielded mixed results (8 –28). Accordingly, we performed a systematic and quantitative meta-analysis to compare the rates of CRBSI and catheter  lonization in single-lumen vs. multilumen catheters.

MATERIALS AND METHODS

This article has zero infections and draws labs from all central lines

Seven years of zero

British Journal of Nursing, 2012 (IV Therapy Supplement), Vol 21, No 21

Harnage