What I am saying is you have biofilm but not
necessarily does the patient have an infection. All catheters develop slime
just like all water pipes do but that does not mean all water sources are
infected that go thru the pipes as well as all patients
bloodstreams
Kathy
From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Lynn Hadaway
Sent: Monday, August 14, 2006 11:21 AM
To: Kokotis, Kathy; Heather Nichols; [EMAIL PROTECTED]; [EMAIL PROTECTED]; Rakay Dance
Subject: RE: Central Line Infection
Kathy,
You will have to do a further explanation for
"Biofilm is not an indicator of CR-BSI."
Biofilm will always be present. We don't have a totally clear understanding
of what causes biofilm to become a CR-BSI, but the two are definitely linked. So
I am not sure what you are saying. Lynn
At 10:31 AM -0600 8/14/06, Kokotis, Kathy wrote:
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
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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
>
>
>
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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
