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Greg Scott
Positive blood cultures prior to placing PICC
I recently received an order to place a PICC in a BMT pt.  He had positive blood cultures drawn a couple day prior to the request, and I asked for repeat cultures.  These cultures were also positive.  The cultures were drawn from a Tri-flo.  The problem is...they want to d/c the patient home.  According to one of our ID MDs  a PICC should not be place in a patient with positive blood cultures.  What is your take on this.  Patient is on daptomycin and zosyn.
lynncrni
I would place the PICC based

I would place the PICC based on the following set of guidelines:

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

momdogz
The Mermel reference is

The Mermel reference is excellent.

I would add that this is a complex issue - i.e. often not black and white.  Things to consider:

if its staphylococcus aureus, in general it would be good to wait until you have no growth in cultures for 48 hours, and treat using other vascular access if you can.

Are you sure the cultures are not contaminants?  Does your lab count colonies, or do semi-quantitative? Were the needleless connectors removed prior to blood sampling (sterile syringe to disinfected hub)?  Getting a simultaneous venipuncture blood sample would be important, especially if using time to positivity.  (refer to Mermel article)

If patient has no access alternatives, a PICC may be best choice but may not want them to go home until cultures negative.

How does the patient appear clinically?  If they're not febrile and their WBC is not trending up - again, it might be ok. 

Without being more directly involved with the patient's case, it's hard to say (but very possible that it's not a "NO". How's that for commital?). 

And, discuss with another ID person - there is some variability in assessment and interpretation between clinicians.

Mari Cordes, BS RN 

Nurse Educator IV Therapy
Fletcher Allen Health Care, Burlington VT

Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center

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