Course Access
Hi Aspasia,
Great question. Biofilm can grow in the fibrin clot/sheath at the tip of the catheter, on the outer surface of the catheter or inside the lumens which in the early stages may just be a single lumen. Needless connectors can also become colonised. The recommendation to culture every lumen is based on Guembe (CID, 2010) who looked at 171 episodes of catheter related bloodstream infection – they found that 37% of infections would have been missed if only a single lumen was sampled. Similar findings from a smaller study by Robinson (J Ped Haem/Onc, 2002) in a paediatric haem-onc population where 32% of 41 episodes would have been missed.
Concern has been raised about the volume of blood required and risk of iatrogenic anaemia. Herrera-Guerra (Am J Infection Control, 2015) proposed a pooled culture technique where blood was taken from each lumen and used to inoculate a single blood culture bottle in comparison to traditional culture of each lumen. Also this was effective, I cannot see that it has been taken up elsewhere. I think this deserves consideration. Another thought I had is to only collect a single aerobic bottle from each lumen, knowing that almost all line pathogens do not need the specialised anaerobic environment – I don’t think this has been studied – has anyone seen this data?
For now, guidelines recommend a set of blood cultures from each lumen in addition to a peripheral set whenever catheter associated bloodstream infection is considered possible. An important aspect to note is that needless connectors should be replaced prior to sampling.
Kind regards,
Ed
Dr Edward Raby
Medical Director of IPC
South Metropolitan Health Service, WA
—–Original Message—–
From: ACIPC Infexion Connexion On Behalf Of Michael Wishart
Sent: Wednesday, 26 October 2022 6:40 AM
To: ACIPCLIST@ACIPC.ORG.AU
Subject: Re: [ACIPC_Infexion_Connexion] 3 lumen Picc line Blood culture
Hi Aspasia
Blood cultures drawn through central device lumens can be very informative in regard to potential sources of infection. If you have positive growth in lumen collected blood cultures, and negative peripheral blood cultures, this can help determine the need for treatment, including the need to remove or replace lines. Blood cultures from lumens that return positive growth more rapidly than peripheral collections can also help guide appropriate treatment and potentially indicate a source.
Cheers
Michael
Michael Wishart | Infection Control Coordinator, CICP-E
St Vincents Private Hospital Northside | 627 Rode Road CHERMSIDE QLD 4032 M +61 448 954 282 | T +61 7 3326 3068 | F +61 7 3607 2226 E michael.wishart@svha.org.au | W https://urldefense.com/v3/__https://www.svphn.org.au__;!!Lav448XFWxY!8bLSSTavpwUE7zNOmuvjTlE3Ke3_chKFmFOtyFtKq8bq_MfWT4rV42xPtRTEE9_xpRFnWn3CQ4JS6LIgzfq1I-dLebxB7O8JFvY$
St Vincents Private Hospital Brisbane | 411 Main Street KANGAROO POINT QLD 4169 M +61 448 954 282 | T +61 7 3240 1208 | F +61 7 3240 1166 E michael.wishart@svha.org.au | W https://urldefense.com/v3/__https://www.svphb.org.au__;!!Lav448XFWxY!8bLSSTavpwUE7zNOmuvjTlE3Ke3_chKFmFOtyFtKq8bq_MfWT4rV42xPtRTEE9_xpRFnWn3CQ4JS6LIgzfq1I-dLebxBGJtjmGs$
—–Original Message—–
From: ACIPC Infexion Connexion On Behalf Of Aspasia Kordanouli
Sent: Tuesday, 25 October 2022 3:56 PM
To: ACIPCLIST@ACIPC.ORG.AU
Subject: [ACIPC_Infexion_Connexion] 3 lumen Picc line Blood culture
Hi all,
Febrile neutropenia patient that has 3 lumen Picc- line insitu, what is the rationale of taking blood cultures of EACH lumen please?
as per eviQ on management febrile neutropenia, 1 set blood cultures (aerobic and anaerobic bottles) from each lumen of central venous access device (CVAD) (if in situ)
What about the blood loss?
Aspasia Kordanouli
Infection Control Nurse
Calvary North Adelaide Hospital
89 Strangways Terrace North Adelaide SA 5006
E: Aspasia.Kordanouli@calvarycare.org.au
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