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Kelmott
Pending Blood Cultures

I was wondering what other PICC teams are doing in regards to pending blood cultures and placing PICC lines? I was told it is not recommended to place them becuase if the cultures are positive then seeding of bacteria on the line can form and possible infect the line. Also what do other teams do if PICC placement is requested for frequent blood draws or testing such as CT Scans? I was told at an INS meeting that most teams do not consider this a viable indication but I do not know what the next step would be. Thanks for any help!!

 

cheaneygr
 We do not place PICC lines

 We do not place PICC lines with pending blood cultures.  We wait 48 hrs to make sure that there is no growth.  That is what the Infectious Disease MDs have recommended.  If a doctor is insistent that a PICC be placed, then we ask them to consult with the Infectious Disease MD to ask if it seems reasonable or not to place a PICC.  Most times the ID doctor says to wait.  If the pt is going to require a long period of frequent blood draws and be in the hospital for some time, then yes we would likely place the picc.  If the pt just needs a line for a CT scan, we place a piv via ultrasound if no one else is able to get an iv in.

lynncrni
 I have just researched this

 I have just researched this issue in the literature. There are no firm recommendations about this and it depends upon the type of CVAD (percutaneous or surgically inserted), availability of other CVAD sites, and the specific organism cultured out. For Staphylococcus aureus, the blood culture should be negative before an new CVAD is inserted, but coag negative Staph means that a new line could be put in more quickly. The best resource on this is:

Mermel LA, Allon M, Bouza E, et al. Clinical Practice Guidelines for the Diagnosis and Management of Intravascular Catheter‚ÄêRelated Infection: 2009 Update by the Infectious Diseases Society of America. Clinical Infectious Diseases. 2009;49(1):1-45.

Here is a new study about this issue stating a very low rate of relapse of the bacteremia (o.9%, I think) but the rate of relapse is even less if you wait at least 3 days between culture results and PICC insertion

Daneman N, Downing M, Zagorski BM. How Long Should Peripherally Inserted Central Catheterization Be Delayed in the Context of Recently Documented Bloodstream Infection? Journal of Vascular and Interventional Radiology 2012;23:123-5.

Lynn

 

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

Chris Cavanaugh
New technology

Regarding your first question, there are antimicrobial PICC lines available, and these would be the best option for patients with pending blood cultures, suspected infections, in need of access.  Many facilities wait 48 hours after cultrures are drawn and antibiotics started via PIV before placing a central line.  This is a recommendation from SHEA.  

Regarding placing a line for other than a long term infusion--that is where the expert vascular access nurse needs to step in, make an assessment of the patients needs and advocate for what is best for that patients.  There are no black and white rules when it comes to patient care. 

Chris Cavanaugh, RN, BSN, CRNI, VA-BC

lynncrni
 Chris, please post the

 Chris, please post the reference from SHEA that you mentioned. I have never seen this statement from SHEA. Thanks, Lynn

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

mheisner
 My question is, I have just

 My question is, I have just started working at a new facility the policy states, "for pending blood cultures, wait 48 hours prior to placement of PICC" however, a physician can insert another type of CVAD. Isn't this two different standards of practice?

lynncrni
 Yes, it sounds that way to

 Yes, it sounds that way to me. A PICC is a CVAD, so why can a physician insert a CVAD when the nurse can not in this 48 hours. Does not make any sense. Lynn

 

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

kevinmcl2003
At our facility because of

At our facility because of the potential of bacterial seeding on a line a PICC is not placed until repeat blood cultures are negative for a minimum of 48 hours, 72 hours for fungal infections. During that time a physician may place a CVAD for access but that is a short term line where bacterial seeding is inconsequential as the line will be removed after a short dwell time. Once the cultures are clear then a PICC may be placed since that line may dwell for up to one year. The problem comes in when a PICC is requested, "for CT scan" or "short term frequent blood draws." Many times this has been requested but after the scan or short period of frequent blood draws....the PICC is left in and not removed. This is where the problem lies. Unfortunately once access is in place many physicians and bedside nurses do not want to remove it and will leave it in just because it is already there and convenient. This is why the policy stands as it is and we do not insert them in the first place until cultures are negative.

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