Infection

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Specializes in ER, Research.

I was wondering, I had a pt admitted who has a Hickman Cath; he had some vague neuro c/o and shaking chills on admission. I drew blood cx on admit and they were neg. Less than 2 days later he had his Hick removed and had a pos. blood cx w/ staph. Is this a contamination from nursing w/ the Hickman, or did he probably have the infection before he came in? I don't believe it was contaminated by me, I was pretty aseptic. Any thoughts?

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Specializes in cardiac/critical care/ informatics.

Did you draw any of BC from the port? Just my first thought.

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Specializes in ER, Research.

Yes, one of the first cx was from the port and it was negative. Less than 2 days later, it showed Staph...I was told it couldn't have shown up that quickly if it was nosocomial, but I just wanted a general opinion from nurses.:D

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Specializes in ED, ICU, Heme/Onc.

side effects. Some cause fever and chills. Was the pt. neutropenic as well? Sometimes a random culture can grow out staph if it is contaminated somewhere along the line from the patient all the way down to the lab. Was the tip of the hickman cultured? Did multiple cultures grow out the same organism? Was this an implanted infusaport (port-a-cath) where you need to access it using sterile technique or was this a chest line with ports intact (like a PICC in the chest wall)? That might make a difference too.

Just brainstorming here. But I would venture a guess that either the patient had an infection on admission or the culture bottles were contaminated. I'm also making a gigantic assumption that this is a heme onc patient so there are a lot of different factors at play with these types of patients.

Blee

I was wondering, I had a pt admitted who has a Hickman Cath; he had some vague neuro c/o and shaking chills on admission. I drew blood cx on admit and they were neg. Less than 2 days later he had his Hick removed and had a pos. blood cx w/ staph. Is this a contamination from nursing w/ the Hickman, or did he probably have the infection before he came in? I don't believe it was contaminated by me, I was pretty aseptic. Any thoughts?
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Specializes in ER, Research.

The pt is not an oncology, but a hematology pt; no chemo. I used aseptic technique on his central line. I don't think I caused the infection b/c of the time from the original negative bc and the pos bc, (

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When the line was removed, it may have broken the biofilm loose, and once those puppies get loose and free, they can cause infection. You couldn't have done anything to prevent it, sometimes things just happen. Some lines have a silver-impregnated coating to prevent them from becoming infected. Foley catheters, too, may be silver coated. Or maybe this pt had an infection somewhere else brewing, that wasn't cultured, and that bug hadn't manifested itself in the blood when the original cultures were done. And to be a line infection, you need cultures from the line and a peripheral draw, to distinguish from a dirty hub or contaminate. The lids to blood culture bottles aren't sterile from the manufacturer, we have to use an alcohol prep to clean it before the draw. I'm just thinking out loud...sorry, I ramble. :)

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Specializes in tele, stepdown/PCU, med/surg.

Blood cx are tricky. My understanding is that even if someone is bacteremic (septic), Blood cx may not grow out anything.

Secondly, central lines are notoriously easy to infect. It's a constant struggle. Thirdly, only positive blood cx is should be ruled a contaminant ESP if it's gram positive. However, in cases of heme/onc patients I can see why they would be extra cautious.

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Specializes in med/surg, telemetry, IV therapy, mgmt.

My first thoughts are why does this patient have a Hickman line? Is it at all possible that he may have received or been on any kind of an antibiotic just prior to being admitted? Even a one time dose of an antibiotic prior to admission could account for the negative blood cultures. It sounds like he had the initial symptoms of the inflammatory response to an infection (the shaking chills). Was his white count also up on admission?

Another reason for the negative blood cultures is that it's possible that the origin of the infection is not the catheter at all, but somewhere else in the body. In a chronically ill patient it is quite possible that an infection could start anywhere. That would account for an inflammatory/immune response which often produces vague initial symptoms as his system was trying to confine it and fight it from getting worse. If this infection then remained untreated it would eventually go systemic and merely take the opportunity to seed itself in the Hickman catheter which has no defense system where it was discovered when blood cultures were drawn again two days later.

The only way to attempt to confirm that this truly was a catheter infection would have been to remove the catheter upon admission and culture the tip as well as draw the blood cultures from another site (a peripheral vein). Blood drawn from a central line that tests positive for bacteria does not necessarily mean the catheter itself is infected. However, to be on the safe side, most practitioners assume that is so and remove the catheter.

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