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picc infections

Our PICC's are being pulled due to spikes in fever, elevated WBC's, etc... but the tips are coming back negative and a new PICC is being placed within 24 hours of cultures being negative. Our infection control is still citing the PICC as the source due to CDC standards. Can someone explain how this is possible. I understand the rationale of it has to come from some source, but if the tip is negative how can it be the PICC?
Any help would be greatly appreciated

PICC infections


I think that your infection control people are using the CDC publication, "Guidelines for the Prevention of Intravascular Catheter-Related Infections" Aug.9, 2002, Vol51/No.RR-10. (this can be downloaded from the CDC website)

The actual definition of a catheter related infection reads: "Bacteremia in a patient with an intravascular catheter, with at least one positive blood culture obtained from a peripheral vein, clinical manifestations of infection, and no apparent source for the infection except the catheter. One of the following should be present: positive culture whereby the same organism is isolated from the catheter segment and peripheral blood."

This means a positive culture from the catheter. Unfortunately, our hospital is doing the same as yours and pulling PICC's despite a negative tip culture. It is very frustrating. The new reimbursement regulations instituted last year are driving this I believe. (no reimbursement for hospital aquired infections, including blood stream infections) If you can obtain this info, see page14 and 27. Despite showing this info to our docs, they continue to have us pull PICC's, but even more frustrating, we cannot replace them until the patient has a negative blood culture.

So - to answer the question - the PICC's are probably NOT the source of the infection.



Janet Eckard

The 2002 CDC document is

The 2002 CDC document is quite old by now and it is in the final stages of revision. Plus the CDC document focuses on prevention, not management of an infection. For management of all CVC infection questions I would turn to the Infectious Disease Society of America. Download their most recent set of guidelines here:

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


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

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

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