Blood cultures

[AMR21, BSN, RN]

I have a question about blood cultures. I'm a PICU nurse. We have pts w dialysis lines a lot. Temporary, permanent, subclavian, femoral. Seen nearly them all. We are good at hep locks/ citrate locks/ even been seeing some TPA locked lines. We are well versed in Bc we run out own CRRT. How about the kid on hemodialysis every other day who spikes a fever and is not due for dialysis yet. I want peripheral, CVL/PICC, Aline cultures before starting new antibiotics. Should I break into the HD line and re lock it? We don't have a protocol yet and I'm interested to see what others do.

[Twinmom06, ASN, APN]

I have a question about blood cultures. I'm a PICU nurse. We have pts w dialysis lines a lot. Temporary, permanent, subclavian, femoral. Seen nearly them all. We are good at hep locks/ citrate locks/ even been seeing some TPA locked lines. We are well versed in Bc we run out own CRRT. How about the kid on hemodialysis every other day who spikes a fever and is not due for dialysis yet. I want peripheral, CVL/PICC, Aline cultures before starting new antibiotics. Should I break into the HD line and re lock it? We don't have a protocol yet and I'm interested to see what others do.

Nope...if your hospital has a dialysis unit you would call the dialysis nurse to come draw if the doctor wants cultures from the line. Quite frankly if they are bacteremic, they are going to have positive cultures regardless of what line it comes from. The hospital I work in strictly forbids cultures from central lines (actually ALL blood draws from central lines are prohibited)

[MunoRN, RN]

If you're not trained to access to dialysis catheters then you shouldn't be drawing cultures off of them, but otherwise it can actually be important to get a sample off of potential sources of bacteria. Generally, a fever alone isn't just cause for blood cultures, you have to weigh the significant blood loss that comes with blood cultures and the possibility of sepsis in the patient. If you want to avoid an unnecessary access of the line on a non-dialysis day, you could draw a set and then decide whether a sample off the line is needed for time-to-positivity testing based on the preliminary results of the first sets. But since routine removal of lines in the case of Sepsis is probably more harmful than beneficial, you really do need to know if the line is a likely source, and getting a sample off the line is really the only way to do that.

And there are less scrupulous facilities out there that don't like samples to be drawn off of central lines, although that's to make it easier for them to fudge their CLASBI data.