Use of the central venous pressure catheter to obtain blood cultures

Fj, Felices Abad; Jl, Hernandez; Ruiz, J Vázquez; Meseguer, Juan; Ja, Gómez Rubí; Molina, E.

doi:10.1097/00003246-197902000-00010

Cited by 36 publications

(8 citation statements)

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“…All studies including preexisting intravascular catheters (1,3,4,8,9), including our study, have shown a higher rate of contamination for catheter-drawn samples; all studies including only newly inserted intravascular catheters (2, 5, 7) have shown no increase in contamination for catheter-drawn samples.…”

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confidence: 46%

“…Previous studies comparing contamination of blood drawn through an intravascular catheter with simultaneous direct venipuncture have shown mixed results and included small numbers of patients (1)(2)(3)(4)(5)(7)(8)(9). To conduct a morecomprehensive comparison of the frequencies of contamination for these two collection methods, we undertook a 2-year retrospective study at a tertiary-care medical center.…”

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confidence: 99%

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Contamination of Catheter-Drawn Blood Cultures

et al. 2001

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To assess the risk of contamination, we reviewed retrospectively 1,408 matched pairs of simultaneous catheter-drawn and venipuncture blood cultures. Catheter-drawn cultures were equally likely to be truly positive (14.4 versus 13.7%) but more likely to be contaminated (3.8 versus 1.8% [P ‫؍‬ 0.001]). Direct venipuncture cultures are preferred.Contamination of blood cultures causes diagnostic confusion and sometimes leads to unnecessary use of antimicrobial agents. Previous studies comparing contamination of blood drawn through an intravascular catheter with simultaneous direct venipuncture have shown mixed results and included small numbers of patients (1)(2)(3)(4)(5)(7)(8)(9). To conduct a morecomprehensive comparison of the frequencies of contamination for these two collection methods, we undertook a 2-year retrospective study at a tertiary-care medical center.Using a computerized database, we identified retrospectively all samples submitted for blood culture from adult or pediatric patients at our hospital between January 1997 and December 1998. From these samples, we identified matched pairs of blood cultures, each consisting of one sample labeled as being taken through an intravascular catheter and the other labeled as being taken by direct venipuncture, both of which were collected from the same patient within a 20-min time span. The specific type of intravascular catheter used was determined from the clinical notes if the label did not contain this information. During the study period, blood culture collection had been undertaken by various nursing and medical staff without standardization of technique. Blood for culture was inoculated into media for processing in a BACTEC 9240 or BacT/ALERT automated blood culture system and incubated either until microbial growth was detected or for 5 days; isolates from positive bottles were identified by standard techniques.Each positive blood culture isolate was categorized by either an adult or pediatric infectious diseases or medical microbiology physician as clinically significant, indeterminate, or a contaminant. This assessment of significance was based on the probability of each microorganism being a skin contaminant, the number of independently collected positive and negative blood cultures in an episode for a patient, the results of other concurrent microbiology tests (e.g., culture of other samples), and the compatibility of the patient's actual clinical features with typical features of infection with that microorganism as described previously by our group (10). An episode was defined as a period beginning with the first positive blood culture and ending when 7 days (2 days for coagulase-negative staphylococci) had passed without another positive blood culture with the same microorganism, regardless of whether negative cultures were drawn in the intervening days (6, 10). Blood cultures yielding one or more contaminants and one or more truly bacteremic organisms were counted under both categories. We calculated and compared true bloodstream infection rates a...

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confidence: 46%

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confidence: 99%

Contamination of Catheter-Drawn Blood Cultures

et al. 2001

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“…Tokars found that when two of two cultures were positive, the positive predictive value would be 98% if both samples were obtained through the vein, 96% if one sample was obtained through a catheter and the other was obtained through a vein, and only 50% if both samples were obtained through a catheter (139). Other studies, however, have not found a significant difference between results of catheter-drawn and peripheral cultures (39,125,158). If it is in fact true that blood cultures obtained from vascular catheters are more likely to be contaminated than percutaneously obtained cultures, the reason may be that sterilizing catheters prior to accessing them is more difficult than sterilizing skin or that catheter colonization is confounding catheter-drawn culture results (151).…”

Section: Source Of Cultures (Catheter Drawn Versus Percutaneous)mentioning

confidence: 99%

Updated Review of Blood Culture Contamination

2006

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SUMMARY Blood culture contamination represents an ongoing source of frustration for clinicians and microbiologists alike. Ambiguous culture results often lead to diagnostic uncertainty in clinical management and are associated with increased health care costs due to unnecessary treatment and testing. A variety of strategies have been investigated and employed to decrease contamination rates. In addition, numerous approaches to increase our ability to distinguish between clinically significant bacteremia and contamination have been explored. In recent years, there has been an increase in the application of computer-based tools to support infection control activities as well as provide clinical decision support related to the management of infectious diseases. Finally, new approaches for estimating bacteremia risk which have the potential to decrease unnecessary blood culture utilization have been developed and evaluated. In this review, we provide an overview of blood culture contamination and describe the potential utility of a variety of approaches to improve both detection and prevention. While it is clear that progress is being made, fundamental challenges remain.

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“…In this model, intermittent bacteremia is accounted for by a lower detection rate. The time span over which multiple cultures may be performed and still be valid in the model is uncertain.Some studies have reported similar results from cultures of blood samples obtained by catheter, compared with cultures of samples obtained by vein [12,20,21], whereas others have found a lower positive predictive value for catheter-obtained blood samples [5][6][7][8]. This model suggests that, if the catheter colonization rate is low (possibly because samples were obtained soon after catheter insertion), spurious positive culture results from catheter-obtained blood samples are unlikely.…”

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Predictive Value of Blood Cultures Positive for Coagulase-Negative Staphylococci: Implications for Patient Care and Health Care Quality Assurance

Tokars

2004

Clinical Infectious Diseases

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Coagulase-negative staphylococci (CoNS) are the pathogens most commonly reported to cause central vascular line-associated bloodstream infection, accounting for 38% of such infections reported to the Centers for Disease Control and Prevention's (CDC) National Nosocomial Infections Surveillance (NNIS) system during 1995. However, CoNS are also common skin commensals that frequently contaminate blood cultures. The misinterpretation of CoNS contaminants as indicative of true bloodstream infections has implications for both patient care and hospital quality assurance.Regarding patient care, unnecessary use of antimicrobials (especially vancomycin) raises health care costs, selects for antimicrobial-resistant organisms [1], and exposes the patient to possible adverse drug effects. Regarding quality assurance, monitoring the rate of catheter-associated bloodstream infections is widely Reprints or correspondence: Dr. Jerome I. Tokars, 1600 Clifton Rd., Mailstop E-55, Atlanta, GA 30333 (jit1@cdc.gov). Clinical Infectious Diseases 2004; 39:333-41This article is in the public domain, and no copyright is claimed. 1058-4838/2004/3903-0007 recommended [2] and practiced. However, the commonly used definition of bloodstream infection [3] (Appendix A) may have limited capacity to exclude contaminants, resulting in inaccurate surveillance data and exaggerating the role of CoNS in bloodstream infection.The CDC "Campaign to Prevent Antimicrobial Resistance" includes a recommendation to treat "infection, not contamination" and suggests that cultures positive for CoNS be interpreted on the basis of the number of positive results among the number of cultures performed [4]. To assist in interpretation of cultures, a mathematical model of blood cultures positive for CoNS in patients with a central vascular line was constructed. To simulate the likely variability among institutions and patient populations, results over a range of possible input values are shown. METHODSThe model had 5 parameters whose input values were chosen to apply to CoNS bacteremia in patients with a central vascular line who had у1 blood culture performed and who did not have an infection with a known source (e.g., endocarditis and surgical wound infection) other than a central vascular line. A single blood culture referred to culture of a sample obtained from a single preparation and puncture, usually inoculated into 2-3 blood culture bottles; if any one of these bottles showed growth, the blood culture result was considered positive. Parameters were assigned initial values on the basis of literature review and varied over a wide range in an attempt to include all reasonable values.Four recent studies, which involved hematology-oncology patients [5], all hospitalized patients [6], surgical intensive care unit patients [7], and medical intensive care unit patients [8], were central in estimating parameter values. These 4 studies reported results of paired blood cultures-one sample from a peripheral vein and one sample from a central vascular line in each patien...

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Use of the central venous pressure catheter to obtain blood cultures

Cited by 36 publications

References 0 publications

Contamination of Catheter-Drawn Blood Cultures

Contamination of Catheter-Drawn Blood Cultures

Updated Review of Blood Culture Contamination

Predictive Value of Blood Cultures Positive for Coagulase-Negative Staphylococci: Implications for Patient Care and Health Care Quality Assurance

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