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James M. Joseph
Policy for Drawing Blood Cultures From a Central line

Our hospital is revising the blood culture policy. I have read the draft and i have some concerns. Is anyone connecting a vacutainer to a central line and drawing blood cultures through it? I worked pediatrics early in my career and we were taught never to draw a blood culture using a vacutainer whether peripheral or central in case the medium in the bottle would infuse into the patient. Any thoughts on this practice? They also want to delegate the blood culture draw to PCAs.

 

 

Angela Lee
I have never seen

I have never seen vacutainers used on central lines and directly connected to blood culture bottles.  Although these bottles have a vacuum, there is always the possibility that one could malfunction and allow culture medium to back up into the line.  There is also the concern about volume.  In pediatrics blood loss from frequent labs is a problem.  In fact, it is finally being recognized as a problem for adults and there's no question neonates suffer because of it.  You cannot measure or easily control the volume of blood taken with the method you describe.

I also have definite concerns about PCAs taking this on.  Who would teach them, monitor them and follow outcomes?  Certainly not the lab tech whose practices may or may not be any better.   Infection related to hub manipulation is a big concern.  In addition, there are situations in which a central line must be trouble shooted- do they have the knowledge base to do that?  What about flushes and heparinization?  What if a central line occludes due to poor technique?

My thoughts are there are too many variables and concerns to support this.  I would not want to be responsible for bad outcomes with this practice and it would be the RN responsible not the PCA.  Yes, unfortunate events can happen with anyone but I think you increase the opportunity when you involve staff who do not have a sound knowledge base to manage lines.  When I think of the issues with the staff RNs already, I cannot imagine PCAs doing any better.

Maria L. Kostylo
We work with an adult

We work with an adult population and do have this option written into our P&P.  I have never heard of the possibility that culture medium could go from the bottle through the vacutainer access and in to the line.  We keep the bottles upright so that you can see that blood is coming in and to determine when the sample is adequate (our bottles have a line to indicate appropriate fill volume).

My understanding is that one less transfer of sample is one less potential for contamination.

Thanks.

Carole Fuseck
James, check the State Board

James, check the State Board of Nursing rules.  (Ohio State U Medical Center?) In Ohio, it is my understanding that even the LPN is unable to draw blood from a central line.  I would therefore believe that it couldn't possibly be delegated to a PCA (assuming PCA is Patient Care Associate). 

Carole

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