Talk with your director of microbiology on this one. At our hospital, our
director of microbiology often got just a tip culture with no accompanying
blood cultures. And only rarely did she ever get the intracutaneous
portion of the catheter. This is written in the procedure. I had one of
our nurses who goes around the hospital doing all kinds of quick procedures
(the "Crisis Nurse") ask staff nurses how to do a tip culture. They all
described it the way you described it. NO ONE knew about the intracutaneous
portion even though the procedure described it.
The problem with just a tip alone is that it rarely comes out positive. If
it does come out positive for staph, then what does that tell you? It
tells you that the tip is positive but it doesn't tell you anything about
the patient.
We are in the process of implementing a housewide computerized charting
system. As soon as it is in place, we plan on educating physicians, nurses
and phlebotomists on the "time-to-positivity" blood cultures. If the
catheter is suspected to be the source of infection, then the physician
would order "time-to-positivity BCs". The nurse sets up at the patient's
bedside and when the phlebotomist draws a peripheral blood culture, the
nurse immediately draws a blood culture from the catheter. Both are sent
off to the Micro lab for processing. They are put in an incubator. If
there are a lot of bacteria from the catheter BCs, then they will grow and
produce CO2 faster compared with the peripheral BC. If the patient is
bacteremic, then the peripheral BC will grow out positive too. The catheter
is the culprit if it grows out 2 hours sooner compared with the peripheral
BC, and both cultures grow out the same organism.
Since the catheter is not often the real culprit, it would save unnecessary
removal of CVCs/PICCs.
For those of you attending the AVA Conference in Sept in Indianapolis, Dr.
Ellen Jo Baron, Stanford Hospital's Director of Microbiology will be
speaking on this very topic.
For those of your who live in the San Francisco Bay Area, the Center for
Education is offering an all day course on "Update on Infection Control
2006: CRBSIs" on June 8th. Call 650-723-6366 to register.
Nadine Nakazawa, RN
PICC Program Coordinator
Stanford Hospital
From: "Jennifer Kettle" <[EMAIL PROTECTED]>
To: [EMAIL PROTECTED]
Subject: catheter cultures
Date: Wed, 31 May 2006 18:16:56 -0700
When culturing for suspected infusion-related infections is it necessary
to obtain both the catheter tip AND the catheter skin segment for
culture? I am still working to develop a standardized care set for our
computer system to help make the diagnosis of suspected CRBSI easier as
well as to encourage consistency. I am also a member of the infection
control committee here. The infection control committee director (MD)
does not feel that it is necessary and compliance with our current
policy to obtain the skin segment is next to none anyhow. I am on the
fence as I am having difficulty interpreting the 2006 standards in
regard to this. We are also in the process of reviewing our current
policy regarding this procedure. Standard #58 under practice criteria E.
states, "When culturing a central vascular catheter segment, either the
catheter tip or a subcutaneous segment should be submitted for culture."
Why would one ever want to culture just the skin segment and not the
tip? Don't you need at least the tip for culture? Any input is always
appreciated. Thanks in advance. Jenny
