RE: Central Line Infection

[Kokotis, Kathy]

Do they do a blood culture thru the line itself that is a quantitative culture?   Catheter tip is unreliable for infection detection   If all else fails I suggest using one of the new brush technologies to diagnose the CR-BSI.    Biofilm is not an indicator of CR-BSI   I have no doubt the patient gets better as the catheter is removed as I believe they are probably ordering broad-spectrum antibiotics which are taking care of whatever infection source they do have such as a wound?   It may/may not be the catheter   I suggest giving them a copy of the CDC 2002 Intravascular Guidelines on defining a CR-BSI.  Catheter tip is not reliable   Kathy       Confidentiality Notice:  This e-mail and any attachments are intended only for the use of those to whom it is addressed and may contain information that is confidential and prohibited from further disclosure under law. If you have received this e-mail in error, its review, use, retention and/or distribution is strictly prohibited. If you are not the intended recipient, please contact the sender by reply e-mail and destroy all copies of the original message and any attachments.[v1.0] From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Heather Nichols Sent: Monday, August 14, 2006 5:13 AM To: [EMAIL PROTECTED]; [EMAIL PROTECTED]; Rakay Dance Subject: Re: Central Line Infection I have been rounding a lot recently with Infectious Disease doc's.  They have shown me beyond a shadow of a doubt, more then once, that you can have an infected line and all negative cultures (blood and tip).  It is the power of deduction.  A patient comes in sick as can be.  Fever, chills, increased abnormal wht count, and has a vascular access device.  They do blood cultures- all negative. They remove the device and culture the tip- comes back negative, but the patient show immediate signs of improvement after the device is removed.  I asked why, and the attending told me that the line can be infected and not show any positive cultures.  Something about biofilm and colonization.  I'm learning.  I'll get back to you when I can spout off long important terms and words.......   Heather Nichols RN BSN CRNI Infusion Services University of Louisville Trauma Institute 530 S. Jackson St. Lou. Ky. 40202 (502)562-3530 >>> "Nancy Moureau" <[EMAIL PROTECTED]> 8/10/2006 3:08 PM >>> Sorry Rakay, Visible Bacteria in a CBC? I assume the white count was up. If all blood cultures are negative both peripheral and line draws then you may be talking about a contaminant. TPN is notorious for growing bacteria and certainly is a risk factor for infection. The patient may have a virus, esp with the glandular swelling. Nancy Moureau, BSN, CRNI PICC Excellence, Inc [EMAIL PROTECTED] 1-888-714-1951 ---------- Original Message ---------------------------------- From: "Rakay Dance" <[EMAIL PROTECTED]> Date:  Thu, 10 Aug 2006 12:41:33 -0600 >Hi,  I am looking for some expert opinions.  We had a PICC line in place >8 weeks.  Pt is receiving TPN for extreme hyperemesis gravadarium.  On >weekly labs Monday the lab noted visiable bacteria in the CBC.  On >Tuesday PICC was pulled and repeat CBC and Blood cultures PIV were >drawn.&nb sp; No bacteria noted on this sample.  Blood Cultures remain >negative after 48 hours.  Is this likely a line infection or something >else.  The tip was not cultured.  Pt is now hospitalized and continues >to spike fevers and is on IVAB.  Infection remains unknown.  Pt's WBC >was 2.7 when admitted to hospital.  Pt has very large swollen glands in >neck, headache and stiff neck.  No spinal has been done.  I would love >your opinion's-line infected or no??  RaKay > > > ----------------------------------------------------- Confidentiality Disclaimer This message, including any attachments, is confidential, intended only for the named recipient(s) and may contain information that is privileged or exempt from disclosure under applicable law, including PHI (Protected Health Information) covered under the Health Insurance Portability and Accountability Act (HIPAA) of 1996.  If you are not the intended recipient(s), you are notified that the dissemination, distribution, or copying of this message is strictly prohibited.  If you receive this message in error, or are not the named recipient(s), please notify the sender or contact the University of Louisville Health Care I.S. helpdesk at 502.562.3637 to report an inadvertently received message. -----------------------------------------------------