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Michelle Todd CRNI
Should PICCs removed due to fevers or actual bactermia (cause not proven) be getting a tip culture?

Some of our Doctors do not order a PICC tip culture even though the documentation says they blame the PICC for the fever or bacteremia. I had heard from the infection control nurse, at the last facility I worked, that maybe PICC tips were not deemed as useful as they used to be. I never got a rationale.

If the patient has a trach, a wound, a urinary catheter and a PICC, it seems like you would want to culture all sources to find the matching organism if there is a bacteremia. 

If you have a positive peripheral BC and a matching positive culture from a PICC blood draw, couldn't the source still be another one besides the PICC? But isn't it still prudent to remove the PICC, do ABX peripherally and PPN for 24 hours, and then replace it?

What if there is a positive culture from the peripheral stick and negative from the PICC blood draw? contaminated peripheral specimen, right?

What if there is a positive culture from the PICC blood draw and a negative one from the peripheral draw? infected PICC, right, or just suspect?

Maybe we captured the organism from the blood in the PICC draw and not the peripheral or visa versa. Wouldn't you still culture the PICC tip to prove that it was the PICC. If the PICC tip is negative, will the hospital be absolved of a CRBI? 



Tip culture requires

Tip culture requires sacrificing the catheter and it only cultures what is on the outside of the catheter wall. Many CRBSIs are caused by intraluminal biofilm therefore culturing the tip only could produce a false negative culture result. 

 I would strongly recommend you locate the following set of guidelines as it will address many of your questions:

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.
This is written by the Infectious Disease Society of America. 


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

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

Kathy Kokotis Bard Access

Kathy Kokotis

Bard Access Systems

Organisms lie below the skin surface so culture of the tip is useless.  Tips can be contaminated. also give you defintion of CR-BSI however it sounds like your infection control group uses the CLA-BSI surveillance defintion.  It would not be in anyone's best interest to report and treat lines that might not be infected.  The only true infection test is CR-BSI by definition.  I would meet with infection control to get a handle on defintions and how reporting is done.  Especially in light of reimbursement.




Kathy Kokotis

Bard Access Systems

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