Blood Culture Panel - Adult Catheter Associated
Epic Lab Code: O116026
Downtime Form: A-1a Clinical Microbiology Laboratory Requisition
Microbiology
BT 6004
356-2591
Bacteriology/Virology Section
Specimen Instructions:
Order Information This order enables diagnosis of a catheter-related bloodstream infection through comparison of the differential time to positivity between cultures drawn from a central line and a venipuncture. Because bacterial load is highest at the origin of the infection (the catheter), a definitive diagnosis of CRBSI is made when identical organisms are recovered from the catheter and peripheral cultures and the catheter culture is positive greater than or equal to 2 hours earlier than the peripheral culture. This "differential time to positivity" can be calculated from the time to positivity reported for each set in Epic. In diagnosing a catheter-related bloodstream infection (CRBSI) multiple sets of bottles and a peripheral venipuncture are REQUIRED. For a single draw from a catheter without a venipuncture please use Epic order LAB8383: BLOOD CULTURE - ADULT instead. Recommendations [1] Fill bottles with equal volumes so that differential time to positivity is accurately calculated. [2] Volume of blood cultured is the primary determinant of whether bloodstream infection is detected. For suspected CRBSI, a minimum of 2 sets of bottles should be sent before initiation of antimicrobial therapy and the bottles should be appropriately marked to reflect the site from which the samples were obtained. For this order, two venipunctures and one sample drawn through any lumen of a catheter are ideal. [3] If no blood sample can be drawn from a venipuncture it is recommended that at least 2 sets should be drawn through different catheter lumens. In this case, check the boxes next to the "site #1, catheter" and "site #4, catheter" orders and fill in the source (e.g. "red lumen" or "PICC") for each in the individual orders that result. If a venipuncture cannot be obtained for what was intended to be a catheter draw, the documented source (catheter) will override the source on the initial order (venipuncture). General Recommendations [1] For procedures, refer to Nursing Policy & Procedure (N-03.020). [2] To maximize volume, use the phlebotomy protocols listed under Reference Links. [3] If molds, Blastomyces, Histoplasma, Nocardia, or Malassezia spp. are suspected, 3 orders (ideally) should be placed for Microbiology: Fungus Blood Culture (LAB2217) as these organisms are not detected well by typical blood culture. For Malassezia, which is sometimes associated with catheters used for CVN/TPN, specify (free text) that this fungus is under consideration so specific cultures are set up. For detection of Candida catheter-associated bloodstream infection a fungal culture is unnecessary and inefficient: instead, draw the volume above and inoculate into two aerobic bottles (no anaerobic bottles).
Collection Medium:
and
Aerobic Blood Culture Bottle Anaerobic Blood Culture Bottle
Testing Schedule:
24 hrs/day, 7 days a week, including holidays.
Turn Around Time:
Cultures are held for 5 days
Methodology:
Automated, continuous monitoring.
CPT Code:
87040