Blood cultures from old CVC

Specialties MICU

Published

I had a patient last week who spiked a temp, had a 2 week old triple lumen in her SC. Horrible peripheral access so I took one set of blood cultures from her central line. A colleague said it was invalid (even for query line sepsis) and that we should continue poking til we get a set from a peripheral poke. What do you think? What would you have done? Thanks for your advice and feedback!

Specializes in GICU, PICU, CSICU, SICU.

Standard Practice in our ICUs is when spiking a temperature we draw at least one blood culture peripherally (or

Specializes in ER/ICU/STICU.

Would have told the doc they need to do a fem stick for the cultures

In my case, my only access was the CVC so that's why I used that. No docs at night in the ICU so fem stick would have been out of the question. I appreciate the feedback. Thank you so much!

So if anything, the culture from the TLC might have at least shown line sepsis?

Specializes in ACNP-BC, Adult Critical Care, Cardiology.

What is your facility protocol? The literature states that in febrile patients with an old CVC, the possibility of a Central Line Associated Bloodstream Infection (CLABSI) should be ruled out. There is strong evidence in the literature that using the Differential Time To Positivity method of obtaining blood cultures is a reliable way of determining whether the bloodstream infection is Central Line related. This method actually calls for drawing a sample of blood from the CVC and another sample percutaneously (phlebotomy) no longer than 15 minutes apart. An identical growth of positive culture reported from the CVC sample and the phlebotomy sample within at least 120 minutes confirms the diagnosis of CLABSI. This has been our facility's protocol so yes, if you were working here you would have followed protocol.

For more info on Differential Time to Positivity, see: Annals of Internal Medicine | Differential Time to Positivity: A Useful Method for Diagnosing Catheter-Related Bloodstream Infections

Specializes in Infusion Nursing, Home Health Infusion.

The draw you did from the CVC would give some information at least whether or not you were able to a sample from a peripheral stick. A better way would be to get a CVC sample and then get a peripheral sample from from a standard draw as the same time or one after the other (paired quantitative blood cultures). I would always get the PIV stick first since that could take more time so you can stay in the window time frame. Make sure you clearly label each source and carefully follow your policy for skin cleansing and port cleansing prior to obtaining each sample. Blood cultures have a notorious high rate of contamination making any data complected almost useless. The draw from the CVC would potentially have a higher rate of contamination. Personally I do not draw a culture through the needleless connectors esp one greater than 5 days old.

What you see if the CVC is the source is appox a 5-10 fold increase in the colony count (same organism(s)) in blood obtained through the intravascular catheter than in blood obtained through a peripheral vein and that is said to be indicative of CR-BSI . As posted the time to positivity is also a great method but the lab has to have the proper equipment to do this.

Te last thing in this scenario is to gather all the data.Is this an antiseptic or antimicrobial catheter? Where was it placed and how (In ED,in a code situation) Is it being used for TPN? Where is the insertion site? (different insertion locations have a higher risk for infection). Does the patient still need central access or can peripheral access meet the pt's needs? Is this percutaneously placed or a temporary CVC or is it a tunneled long term CVC? Where is the tip location....still good or not?

Although there is no current recommendation at the exact time frame that certain type of CVCs can stay in place the trend and mandate is definitely in monitoring for the need daily in hospitalized pts and justifying the need and NOT leaving them in too long. Routine exchange is NOT recommended either. We would draw the cultures,place a PICC most likely and pull the CVC and culture the tip as well, The actual culture of the CVC is really the only way to 100 percent sure the CVC was the source. Look at the whole picture though and see if is really worth trying to save the line. Look for other sources of infection and as the ID practitioners always tell me....look at the patient and their symptoms.

Specializes in Infusion Nursing, Home Health Infusion.

oops dbl post

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