Blood Culture in BMT Patients

CelticGoddess, BSN, RN · Jun 24, 2016

To those of you who work with Oncology/BMT patients - do you change the needleless connectors on CVCs before blood cultures? We have been looking at literature around changing the connectors before drawing blood for culture to reduce the chance of a false positive culture. This practice seems fine for normal patients but in the BMT world we are worried about the risk of manipulating the line even more by changing caps (some patients have cultures drawn every 24 hours while febrile). Thoughts?

It is the policy at my facility to change the caps on Wed/Sat and to change after: Chemo, blood, TPN, lab draws, and when changing dressing or changing out the huber. The caps are sterile if the package is unopened. We don't change the caps before blood draws, only after.

Since going to the currently policy (about 9mos ago) we have only had one CLABSI and that one actually was admitted with it.

We currently don't have a BMT unit yet (new facility to open in 2018 will have BMT unit) so I can't address that area. But we do get a lot of neutropenics.

KRVRN, BSN, RN · Jun 25, 2016

I work NICU and our mentality is like yours, manipulate the line as least as possible. We don't change the cap to draw cultures. We really only change it if we suspect it is clotted. I imagine you have to trust your hub scrub procedure when drawing cultures the same as when infusing via the line. If it's not sterile enough to dtaw cultures, is it sterile enough to infuse through?

blondy2061h, MSN, RN · Jun 25, 2016

In our BMT unit we change the caps q96 hours (with tubing), and q24 hours with TPN or lipid based drips (Propofol). We do not change caps with cultures. We absolutely try to minimize cap changes. I can't imagine changing after all of the things the first reply said.