How to draw blood cultures from a PICC line.

[mibbycat]

A patient is being treated for osteomyelitis with Rocephine through their PICC. She was recently treated in the ER for an allergic reaction and the PICC line was accessed to give meds there. The patient reported that at one point, the ER nurse handled the PICC line without wearing gloves or first washing their hands. About 24-48 hrs later the patient developed a 99.5F fever for 2 days. The fever spiked to 102F on the 3rd day. The patient also had a swollen and tender cervical lymph node that developed the same time as the fever. The patient also reported extreme fatigue, headaches, and "slight warmth and burning" in the arm with the PICC during those 3 days. There was a question of whether the patient's fever was from an infected PICC line or an adverse reaction to Rocephin. An order was placed to draw blood cultures peripherally and from the PICC line.

What is the proper way to draw blood cultures from PICC line?

If the PICC line draws blood ok, is it best to draw blood into the cultures without first flushing and wasting blood?

Or is it best to first flush the PICC line and waste blood before drawing the blood cultures? Wouldnt this method flush the bactieria out of the PICC and reduce the chance of a successful culture.

[07302003, ASN, RN]

For blood cultures from a PICC, mediport, or other central line you draw back and use that sample, no flushing, no wasting. This is the only blood sample you take without a flush and waste. Your instinct was correct!

[IVRUS, BSN, RN]

You are correct. Draw from the PICC, no waste, and no discard. Also remember, however, that you should NOT draw through the INJECTION cap. Do a direct connection or change caps before culture.

Note; some institutions refuse to draw cultures from their lines, but rather do peripheral VP's and assess time to positivity, or colony counts.

[tbpmom]

Coluld you please send me any polices and literature you may have supporting the practices you mentiond please?

I am having trouble finding any literature regarding guidelines/best practice with drawing blood cultures fro the pICC line.

Our system says to remove the end cap and flush before drwing any blood. Also staff are to draw 5 mls for waste, then draw the 8-10 mls for each aerobic and anaerobic bottle, place a new endcap and flush with 20 mls. I question why flush before, and why draw a waste with blood culture samples. Thanks.

[karlikn]

you still have to draw and to discard blood first even if you don't flush the  line with normal saline. Line is already filled with either normal saline,  or heparin, or ethanol, so you need to remove it before drawing blood for culture, plus to remove some blood since it can get mixed with mentioned above solutions.

Did you ever looked closely into blood that gets discarded when drawing blood for regular tests from central line? I did. It looks more light colored first, then it looks normal.