Course Access
Dear Cate, it is only recomended to do a tip culture if there is a
suspected catheter related bloodstream infection, as well as percutaneously
drawn BCs (IDSA Guidelines – attached).
Of course some lines are not removed even if CRBSI is suspected (e.g.
Hickmans may try to be salvaged with an ethanol lock etc), so in those
cases it is recommended to take a percutaneously drawn blood culture PLUS a
CVC drawn blood culture – as you can diagnosis CRBSI that way using
differential time to positivity criteria (IDSA).
There is no benefit in routine tip culturing off all lines, as you don’t
pick up any more CRBSI, than if you do it on clinical suspicion of CRBSI
(Maki – attached). As you point out, a +ve tip culture on its own is
difficult to attribute meaning to, unless there is also a +ve BC.
In QLD we stopped doing routine tip cultures on all CVCs several years ago.
Sometimes even if CRBSI is suspected and the line removed, we keep the tip
in pathology until the BC finishes growing, and only culture it if the BC
is positive. I don’t know if anyone has validated how long that is OK to
do, but that can be a practical decision sometimes depending on lab staff
availability etc.
Healthy wishes
C
On 16 March 2017 at 12:42, Cate Coffey wrote:
> Hi everyone
>
> We are updating our policies and I notice that our CVC and Vascath polices
> recommend culturing the tip of CVC. Could you tell me if there is evidence
> to support this practice Wouldnt a blood culture be more appropriate to
> diagnose infection? Can there be a CVC tip infection without bloodstream
> infection and what is the relevance if there is?
>
> We do not have 24 hour pathology service so it means that tip cultures
> could only be sent during lab hours?
>
> Can you let me know your thoughts?
>
> *Cate Coffey | *Clinical Nurse Consultant
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