Re: catheter cultures

[Jennifer Kettle]

What we have decided to do is swab the skin with alcohol, allow to dry, and then pull the line while obtaining the tip for culture. We are generating a careset that requires the MD to draw a peripheral QBC & peripheral standard blood culture (divided into aerobic and anaerobic bottles) and a line draw QBC (from each lumen) prior to discontinuing the line. Then, we will have answers as to if our lines are being pulled prematurely, etc. We will then have a definitive diagnosis or not. Of course, we do more than encourage all the blood culture draws and to maintain the lines while we await results. Being that the docs are not always real cooperative we decided that we wanted real concrete answers for the infection control committee folks, etc. The QBCs' will catch an internal lumen colonization and possible bacteremia. The standard cultures will be compared to the tip culture. This will tell us if the line is colonized only or not and also if it has seeded systemically. We had talked about doing the tip culture with sonication. Upon research, we (the head of micro here & I) found this to not be cost effective. Sonication would put the tip in a liquid medium in which it would be sonicated (i.e. gentle vibration) resulting in any bacteria within the internal lumen of the tip (or catheter segment) to enter the liquid which is then cultured. We decided that we could obtain this with our QBC draws in order to catch an internal lumen colonization. Anyhow, this has been quite a project for me. Thanks for all of the input from the list serve. Jenny Kettle, RN, BSN (hopefully to soon be CRNI  :-) >>> "Christine NAYLOR" <[EMAIL PROTECTED]> 6/6/2006 7:59:56 AM >>> Interesting. I have never heard that. I am wondering if you could just swab the skin without taking a segment. Chris Chris Naylor RN, CRNI [EMAIL PROTECTED] PICC/PRN Team Managerr Santa Rosa Memorial Hospital 1165 Montgomery Dr. 1W07 707-522-1591 Santa Rosa, CA 95405 FAX 707-525-5378 Consistency,Responsibility,Harmony, Achiever, Relator >>> "Jennifer Kettle" <[EMAIL PROTECTED]> 6/1/2006 3:40 PM >>> I was told by the director of my department that the segment culture was to correlate with the tip culture. If both are found positive for the same bug then we would theoretically know that the bug had migrated from the insertion site and that the catheter was not colonized r/t another unrelated infection that the patient has. I understood it to be an attempt to try to define where the colonization came from. This makes me think that it may help our cause in that many times it doesn't come from the actual site itself. On the other hand, if it does then we need to know that too for educational purposes  in order to improve bedside nurses knowledge about the care and maintenance of these lines. We try to culture the site if it is appropriate based on drainage, etc. which I sure hate to ever see. Thanks. Everyone has been so helpful and it is appreciated.  Jenny >>> "Christine NAYLOR" <[EMAIL PROTECTED]> 6/1/2006 1:56:40 PM >>> A skin segment would be for an infected site. The catheter tip would be more of what is going on with the catheter and blood stream. chris Chris Naylor RN, CRNI [EMAIL PROTECTED] PICC/PRN Team Managerr Santa Rosa Memorial Hospital 1165 Montgomery Dr. 1W07 707-522-1591 Santa Rosa, CA 95405 FAX 707-525-5378 Consistency,Responsibility,Harmony, Achiever, Relator >>> "Jennifer Kettle" <[EMAIL PROTECTED]> 5/31/2006 6:16 PM >>> 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 Notice from St.Joseph Health System: Please note that the information contained in this message may be privileged and confidential and protected from disclosure. Notice from St.Joseph Health System: Please note that the information contained in this message may be privileged and confidential and protected from disclosure.