Your comments describe signs and symptoms of an exit site
infection, but not a bloodstream infection. Most bloodstream
infections will not have signs and symptoms at the exit site. I would
do blood cultures - one from the PICC and one from a peripheral site.
When you can not do time to positivity, compare the colony counts from
each specimen. If the one drawn from the catheter is at least 5 times
greater than the other sample, the catheter is implicated. How long
has this PICC been indwelling? The 2 most common routes for BSI is
skin around the insertion site (usually seen shortly after insertion)
or hub manipulation (usually seen with long time dwell). Seeding from
another infected site could be the source, but this is much less
likely than the other 2 sources of bugs. Lynn
At 8:21 PM -0900 12/27/05, Betsy Harmon wrote:
New question for the group.
Had a physician today ask if I had ever heard of a patient having an infected CVC or PICC but was totally asymptomatic? No erythema, tenderness, drainage, etc at the insertion site of up the extremity for a PICC. No other symptoms except for a high WBC?
CT of head chest and abd done today on patient
Blood cultures pending
Sputum cultures growing lots of funky stuff. No CXR ordered since 10/13/05
UA sent for culture and sensitivity pending
Pt has partial Bowel obstruction. Has g-tube, and severe abd tenderness
PICC site soft, non-tender complete up inner aspect of arm to axilla when palpated. No increase in arm circumference, no increase in forarm circumference. No pain across anterior chest, both lumens flush like a dream. No erythema, drainage or swelling at insertion site.
Physicians want to pull the PICC for suspected infection source. Any help to the two questions posed in the first paragraph? I have asked enough questions about the patient they are waiting until something really indicates the PICC as the source. We do not do "time to positivity" cultures yet at our facility, the lab is looking into this for me.
Thanks in advance.
Betsy Harmon RN BSN CRNI
Vascular Access Team
Critical Care Unit
Alaska Native Medical Center
Anchorage, Alaska
[EMAIL PROTECTED]
--
Lynn Hadaway, M.Ed., RNC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
http://www.hadawayassociates.com
office 770-358-7861
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
http://www.hadawayassociates.com
office 770-358-7861
