[Daniela Karanfilovska]

Hi Aspasia,

I agree with all the responses provided re: rationale for blood culturing each lumen, this is necessary when you are completing a full set of BCs (especially for the first fever). However I understand your concern about frequency of culturing a patient with febrile neutropenia, we know they may spike multiple fevers per day over many days. Other issues associated with this include –

Patient discomfort (as blood culture sets should include a peripheral collection)

The yield from repeated culturing may become negligible over the coming days (blood culture positivity may reduce with administration of antibiotics).

Iatrogenic anaemia may be a real concern in some patients, especially paeds.

Every blood culture procedure may come with a risk of infection, if there is a lapse in aseptic technique

We have a policy regarding frequency of blood culturing patients with febrile neutropenia which limits the number of blood culture sets taken in stable patients after the first 24 hours of fever. It would still mean a patient with a 3-lumen PICC would have every lumen sampled, but if the patient had fevers >24 hrs we wouldnt necessarily culture with every single fever (if the patient remained stable and is receiving antibiotics).

Kind regards
Daniela

Daniela Karanfilovska
Senior Clinical Nurse Consultant
Infection Prevention & Healthcare Epidemiology
e D.Karanfilovska@alfred.org.au

Please note I now work remotely & part time.

Alfred Health
55 Commercial Road
Melbourne VIC 3004
PO Box 315 Prahran
VIC 3181 Australia
[cid:image001.jpg@01D5FBA0.4B195C30]
We acknowledge the people of the Kulin Nation, the traditional custodians and pay our respects to their culture and their Elders past, present and emerging.
We welcome all cultures, nationalities and religions. Being inclusive and providing equitable healthcare is our commitment.

Alfred Health incorporates The Alfred, Caulfield Hospital, Sandringham Hospital and Melbourne Sexual Health Centre
http://www.alfredhealth.org.au

CONFIDENTIALITY NOTICE: This email and any files transmitted with it are confidential and are to be used solely by the individual or entity to whom it is addressed. If you have received this email in error, please be aware that any disclosure, copying or distribution of the information it contains; or taking any action in reliance on the contents of this information, is strictly prohibited and may be unlawful. Please notify us by return email that you have received the email and delete all copies in your system.

Please consider the environment before printing this email.

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

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—–

CAUTION External Communication: This email originated from outside of the organisation. Do not click links or open attachments unless you recognise the sender and know the content is safe.

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$

StVincents 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$

—–OriginalMessage—–

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

https://urldefense.com/v3/__http://www.calvarynorthadelaide.org.au__;!!LUsMDrd6!mzAOsp0GAmG-vWMDsVxHCjEJ-Q3ri5dt7CyWcr9htC9LPxkeAcf910hj0mlArWZSEn-2C4jmNl9x78QxtPffQfYJXRDWDSLppASVO8CG$

MESSAGESPOSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.

The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.

Archive of all messages are available at https://urldefense.com/v3/__http://aicalist.org.au/archives__;!!LUsMDrd6!mzAOsp0GAmG-vWMDsVxHCjEJ-Q3ri5dt7CyWcr9htC9LPxkeAcf910hj0mlArWZSEn-2C4jmNl9x78QxtPffQfYJXRDWDSLppI8AE9M2$ – registration and login required.

Replies to this message will be directed back to the list. To create a new message send an email to acipclist@acipc.org.au

To send a message to the list administrator send an email to admin@acipc.org.au

You can unsubscribe manually from this list by sending ‘signoff acipclist’ (without the quotes) to listserv@aicalist.org.au This email and any attachments to it (the “Email”) is confidential and is for the use only of the intended recipient, and may not be duplicated or used by any other party without the express consent of the sender. If you are not the intended recipient of the Email, please notify the sender immediately by return email, delete the Email, and do not copy, print, retransmit, store or act in reliance on the Email. St Vincent’s Health Australia (“SVHA”) does not guarantee that the Email is free from errors, viruses or interference. Emails to and from SVHA or its related entities may be scanned and filtered in locations outside Australia

MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.

The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.

Archive of all messages are available at https://urldefense.com/v3/__http://aicalist.org.au/archives__;!!Lav448XFWxY!8bLSSTavpwUE7zNOmuvjTlE3Ke3_chKFmFOtyFtKq8bq_MfWT4rV42xPtRTEE9_xpRFnWn3CQ4JS6LIgzfq1I-dLebxBQL1KYCk$ – registration and login required.

Replies to this message will be directed back to the list. To create a new message send an email to acipclist@acipc.org.au

To send a message to the list administrator send an email to admin@acipc.org.au

You can unsubscribe manually from this list by sending ‘signoff acipclist’ (without the quotes) to listserv@aicalist.org.au

MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.

The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.

Archive of all messages are available at https://urldefense.com/v3/__http://aicalist.org.au/archives__;!!NDYExDT0u85SdT4!oddgGoQwU40FRoH3VgFtxxuDyDEStFWpMvqiB4YM7DAYb46ttmmqjvnBQVbqCOwD571rqbUTsR9_gsUvFQN-nbKAOT4hxGaXvCxy6w$ – registration and login required.

Replies to this message will be directed back to the list. To create a new message send an email to acipclist@acipc.org.au

To send a message to the list administrator send an email to admin@acipc.org.au

You can unsubscribe manually from this list by sending ‘signoff acipclist’ (without the quotes) to listserv@aicalist.org.au

MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.

The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.

Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.

Replies to this message will be directed back to the list. To create a new message send an email to acipclist@acipc.org.au

To send a message to the list administrator send an email to admin@acipc.org.au

You can unsubscribe manually from this list by sending ‘signoff acipclist’ (without the quotes) to listserv@aicalist.org.au

[Author]

Posts