Intravenous literature: Halm, M., Hickson, T., Stein, D., Tanner, M. and VandeGraaf, S. (2011) Blood Cultures and Central Catheters: Is The “Easiest Way” Best Practice? American Journal of Critical Care. 20(4):335-338.
Bacteremia is a life-threatening condition associated with significant morbidity and mortality. Common sources of bacteremia include the genitourinary and respiratory tracts and surgical wounds/abscesses, although there are less common causes. Therefore, rapid detection, identification, and susceptibility testing of blood culture isolates are of utmost diagnostic importance. Most bacteremias are intermittent and require multiple culture sets to be obtained. Although it may be convenient to obtain blood samples for culture from central catheters, expert opinion and clinical guidelines discourage this practice because of concerns of contamination that increases false-positive rates, as well as catheter-related bloodstream infection that may lead to greater (and sometimes unnecessary) use of antibiotics, longer hospital stays, and higher costs associated with the longer stays.
Thus, the following PICO question (patient/problem, intervention, comparison, outcome) was raised by our clinical team: Among hospitalized patients, are samples obtained via peripheral venipuncture or central catheters, as well as single or paired blood culture sets, associated with the greatest sensitivity and specificity in detecting bacteremia? In examining the literature on this original question, other best-practice pearls related to timing, preparing, obtaining samples, and labeling were uncovered.