EVD cultures: What do you practice in your setting? Help! Need info!
- 0Jan 28, '10 by SBlackburnHello 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.
- 0Jan 28, '10 by janfrn Asst. AdminWe 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.
- 0Jan 30, '10 by janfrn Asst. AdminI 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...)
- 0Jan 31, '10 by rnguy25We 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.
- 0Jan 31, '10 by Scooby484kThis 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
- 0Feb 1, '10 by SBlackburnthanks 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.
- 0Feb 13, '10 by janfrn Asst. AdminOkay, 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.