I am reaching out to my colleagues who have hopefully asked the same question. Does anyone know of any solid evidence that can determine if a CLABSI is definitely associated with the insertion versus maintenance? I think many years ago I was told about the "time to positivity" of the cultures, however our hospital does not do this. Also what significance does a tip culture provide to the line infection? I ask because rarely, if ever do we see a positive tip culture, but see a positive blood culture from the line (not just PICCs, in this case). Thanks for your input!
There is no way to definitely determine the answer to this in a patient-specific manner. Research shows that there is more biofilm on the extraluminal side of the catheter within the first 10 days of dwell. At 30 days there is more biofilm on the intraluminal surfaces. Dr Maki published a study on this many years ago for inpatients with CVADs. Roughly 1/3 was determined to be extraluminal, another 1/3 roghly was intraluminal, and the rest could not be determined.
Also you would be talking about a CRBSI, not a CLABSI. See CDC guidelines for the differences.
Time to positivity is a lab technique to diagnose a CRBSI. It is not intended to determine the cause of that CRBSI.
Culturing the catheter tip will only culture what is on the extraluminal surface and will not culture what is on the intraluminal surface. Tip cultures are not done much anymore from what I am seeing. For the ones with a positive blood culture, are you certain that this has not been ruled to be a contaminant? That is the first thing to assess. If this is a pathogenic organisms, then you must address how that catheter is cared for while it is being used. Following all standards for care especially focusing on the hub and what is being done with it. Set management, needleless connector maintenance, etc. \
Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
I looked at the issue of positive tip cultures myself several years ago and found them to be somewhat unreliable. I looked at one years worth of CLABSI results, then looked through medical records to see if a tip culture was performed. I found that only 45% of the time when the blood culture was positive and the tip was cultured did the tip grow anything. Keep in mind that the Maki roll technique will expose the agar to whatever is on the outside of the catheter, but not very well to what is inside. When you take the catheter out you are stripping some of what is living on the outside of the catheter. Sonocation of the line would be better, but is more expensive.
Stuart Gordon, MSN, RN, CRNI, VA-BC
Legacy Health
S Gordon
Thanks for your feedback!
Cindy Hunchusky, BSN, RN, CRNI