When should central venous catheter tip culture be undertaken

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#IVTEAM #Intravenous literature: “Catheter tip cultures should not be submitted to the laboratory unless CRBSI is suspected as the predictive value of culture results depends on the pretest probability of CRBSI.”O’Flaherty and Crowley (2014).

Reference:

O’Flaherty, N. and Crowley, B. (2014) How to use central venous catheter tip cultures. Archives of Disease in Childhood. Education and Practice Edition. April 7th. [epub ahead of print].

Abstract:

Central venous catheter (CVC) tip cultures are useful in the assessment of a patient with a potential catheter-related bloodstream infection (CRBSI). However, these results can be misleading particularly in the absence of concomitant peripheral and central line blood cultures. Catheter tip cultures should not be submitted to the laboratory unless CRBSI is suspected as the predictive value of culture results depends on the pretest probability of CRBSI. A positive CVC tip culture does not usually warrant further investigation or therapy (except in the case of Staphylococcus aureus and possibly Candida sp) while a negative catheter tip culture in isolation does not definitively exclude CRBSI. Clinicians can use alternative criteria for the diagnosis of CRBSI that do not require catheter tip cultures if necessary. Further research into the significance of CVC tip cultures in the absence of concomitant bacteraemia is required.

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