Hello fellow PICU nurses!
I'm looking to see what is your current practice with sending EVD cultures. Do you follow a protocol to send them daily, twice a week, only when needed, etc.? Also, who sends them? The nurse or doctor? Or someone else? I am looking to explore this further, but I could use some help from you guys! If you have a protocol you could send that would be even better! Any response to this would be much appreciated.
Jan 28, '10
We used to send them daily, but our protocol changed about a year and a half ago to "as ordered only". RNs are covered to collect the sample from the sample port between the graduated cylinder and the collection bag, using sterile technique. I'll see if I can get you a copy of our policy when I go to work tomorrow night.
Jan 30, '10
That would help tremendously! I am looking to create a protocol that specifies this particular aspect.
Last edit by NotReady4PrimeTime on Jan 30, '10
: Reason: removed personal email address
Jan 30, '10
I wasn't able to look up that policy last night... the unit was too busy and my computer terminal kept freezing on me. I'm off now for 9 days, but i may have a copy of it in my old orientation manual. I'll check and then I'll let you know. Oh, and I've removed your personal email address from your post for security reasons. I'll be able to get it to you by email anyway. You've ticked the box in your profile that allows members to send you email without having to include the address. (Much safer to let our server handle that...)
Jan 31, '10
We collect our EVD cultures or samples from the sample port that is proximal to the patient using sterile technique. RNs are allowed to collect CSF samples, but not allowed to infuse any meds or flush the EVD tubing. If there is a known infection, we typically send daily cultures until negative for a given number of days. We'll send cultures as needed only to rule out infection if an indication is given, such as a spike in temp.
Jan 31, '10
This may not exactly be what you're asking, but.....
At our hospital, only neurosurgery docs are allowed to collect specimens. We can change the EVD bags with sterile technique, but that is the limit. Generally speaking, if an infection is suspected, the child is cultured in the OR when they are externalized, then started on antibiotics. Three consecutive days of negative cultures collected by neurosurgery are required before the infection is "cleared" ... well, not cleared exactly, but the time it took to reach this stage helps determine the length of the course of IV abx that child needs (usually a few weeks), and also determines when the child's shunt can be reinternalized. (They usually wait until the antibiotics are at therapeutic levels before they start checking... although honestly neurosurg doesn't always stick to their own policies).
Hope that helps a little.
Last edit by Scooby484k on Jan 31, '10
: Reason: needed to correct some details
Feb 1, '10
thanks rnguy25 and scooby484k!
your input is great. i really appreciate you taking the time to write a response. i'm trying to change the practice of daily culturing (in the absence of s/s of infection) and wanting to collect info to help build a case. it seems other hospitals don't practice this way; they only culture if indicated as you have both described.
Feb 13, '10
Okay, so I finally had a chance to pull out our policy. But I'm not going to send it to you... it's too embarrassing. The thing hasn't been updated since 1994. When next I work a day shift (not till the end of next week...) I'll see if I can corral the director of our ID service (she's a friend) and ask her for her input.
Feb 15, '10
Don't feel you're the only one with outdated policies. I've seen plenty around here! Thanks for your help on this!
Mar 16, '10
janfrn, rnguy25, and scooby484k,
Would you mind letting me know (you can do so offline if you wish) what city and state you practice in, which unit, and what type of institution i.e., tertiary, children's medical center, small community hosp, etc. I am collecting data and comparing practices across different institutions. This would really help me out. If you can still provide me with your policies or protocols, that would be excellent! If I can be clear on this: rnguy25 - if infection is not present, you guys culture only when indicated? scooby484k - do you have a protocol for sending CSF samples either daily or on certain days when infection is not present or suspected? Thanks again!
Mar 24, '10
I work in a 16 bed PICU and we are affiliated with a medical school. EVD cultures are only sent per MD request and the MD is the only one who can collect it. RN's can only change the EVD collection bag.
Apr 1, '10
Thank you RunningRNBSN; Would you mind telling me what city and state your PICU is in? I am collecting data in order to try to change practice in this institution that sends daily surveillance cultures for their pediatric patients. Also, Jnfrn, I received your last email, but I have no way of responding to it. You can send to email@example.com
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