2.50
Hdl Handle:
http://hdl.handle.net/10755/162397
Type:
Presentation
Title:
Pilot Study - Blood Culture Accuracy: Central Venous Catheters Blood Discards
Abstract:
Pilot Study - Blood Culture Accuracy: Central Venous Catheters Blood Discards
Conference Sponsor:Emergency Nurses Association
Conference Year:2010
Author:Pai, Debra, RN, BSN, CEN
P.I. Institution Name:St. Joseph Hospital
Title:Clinical Nurse III
Contact Address:1100 W. Stewart Drive, Orange, CA, 92683, USA
Contact Telephone:714-771-8250
Co-Authors:Elizabeth Winokur, RN, MSN, CEN; Dana Rutledge, RN, PhD; Christine Marshall, RN, MSN, CEN, CPEN; Paul Sheikewitz, MD; Kate Vogel, BS, MA
[ENA Annual Conference - Research Presentation]

Purpose: Our current hospital policy requires a 5 mL discard prior to obtaining blood cultures. In the emergency department (ED), we frequently see pediatric oncology patients who are have central venous catheters (CVC) and are potentially septic, requiring blood cultures. Blood draws may exacerbate pre-existing anemia in these vulnerable patients.

Telephone/email surveys of national pediatric and oncology centers demonstrated wide variability in practice related to discarding blood when obtaining CVC specimens. No research evidence clearly supports one practice. While funding for a larger study is sought, pilot work was conducted to determine study feasibility. IRB approval was obtained.

Design: A comparative design was used to determine if the blood normally discarded from the CVC had diagnostic agreement with the care-as-usual blood culture.

Setting: ED of a large Southern California Community Hospital.

Subjects: A convenience sample of pediatric oncology patients admitted to the ED with a CVC and order for blood cultures. Funding was obtained for 48 'blood culture study' bottles.

Methods: Following team meetings with laboratory personnel to design reporting processes, six RNs in the ED were trained by the lead investigator for data collection. Pediatric oncology patients with blood culture orders were potential study candidates. During specimen collection, the first 5 mL of blood (specimen 1; normal discard) and the second sample (specimen 2; care-as-usual) were both used for blood cultures. Specimen 1 was labeled 'blood culture study.' Data analysis determined agreement in culture results in terms of findings (positive/negative) and organisms if positive; also sensitivity, specificity, positive and negative predictive values of specimen 1 were determined. The team physician determined whether culture results were likely skin contaminants. Positive blood cultures from both specimen 1 or 2 were reported to patients' treating physicians.

Results: In all cases results from specimen 1 matched specimen 2. About 12 % of cultures produced positive results. However, an unexpected finding was that the time to positivity in several cases was 4 to 8 hours earlier in specimen 1 (normal discard) than specimen 2.

Implications: This project challenges a specific component of a common clinical practice, withdrawal of laboratory specimens from CVCs. Given the significant variability among pediatric/oncology centers as to using or not using first withdrawn CVC blood specimen for cultures in children, evidence is needed to establish practice recommendations. Given that the pilot study demonstrates that the normally discarded specimen has been equivalent to careûas-usual, this study may lend support to the practice of decreasing amount of blood necessary for accurate blood cultures. Further, the unexpected finding of earlier positivity provides the opportunity to provide definitive antimicrobial care sooner. Additional study with a larger population is necessary to verify these results.
Repository Posting Date:
27-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Emergency Nurses Association

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titlePilot Study - Blood Culture Accuracy: Central Venous Catheters Blood Discardsen_GB
dc.identifier.urihttp://hdl.handle.net/10755/162397-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Pilot Study - Blood Culture Accuracy: Central Venous Catheters Blood Discards</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Emergency Nurses Association</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2010</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Pai, Debra, RN, BSN, CEN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">St. Joseph Hospital</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Clinical Nurse III</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">1100 W. Stewart Drive, Orange, CA, 92683, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">714-771-8250</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">debbie.pai@stjoe.org</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Elizabeth Winokur, RN, MSN, CEN; Dana Rutledge, RN, PhD; Christine Marshall, RN, MSN, CEN, CPEN; Paul Sheikewitz, MD; Kate Vogel, BS, MA</td></tr><tr><td colspan="2" class="item-abstract">[ENA Annual Conference - Research Presentation] <br/><br/>Purpose: Our current hospital policy requires a 5 mL discard prior to obtaining blood cultures. In the emergency department (ED), we frequently see pediatric oncology patients who are have central venous catheters (CVC) and are potentially septic, requiring blood cultures. Blood draws may exacerbate pre-existing anemia in these vulnerable patients. <br/><br/>Telephone/email surveys of national pediatric and oncology centers demonstrated wide variability in practice related to discarding blood when obtaining CVC specimens. No research evidence clearly supports one practice. While funding for a larger study is sought, pilot work was conducted to determine study feasibility. IRB approval was obtained.<br/><br/>Design: A comparative design was used to determine if the blood normally discarded from the CVC had diagnostic agreement with the care-as-usual blood culture. <br/><br/>Setting: ED of a large Southern California Community Hospital.<br/><br/>Subjects: A convenience sample of pediatric oncology patients admitted to the ED with a CVC and order for blood cultures. Funding was obtained for 48 'blood culture study' bottles.<br/><br/>Methods: Following team meetings with laboratory personnel to design reporting processes, six RNs in the ED were trained by the lead investigator for data collection. Pediatric oncology patients with blood culture orders were potential study candidates. During specimen collection, the first 5 mL of blood (specimen 1; normal discard) and the second sample (specimen 2; care-as-usual) were both used for blood cultures. Specimen 1 was labeled 'blood culture study.' Data analysis determined agreement in culture results in terms of findings (positive/negative) and organisms if positive; also sensitivity, specificity, positive and negative predictive values of specimen 1 were determined. The team physician determined whether culture results were likely skin contaminants. Positive blood cultures from both specimen 1 or 2 were reported to patients' treating physicians.<br/><br/>Results: In all cases results from specimen 1 matched specimen 2. About 12 % of cultures produced positive results. However, an unexpected finding was that the time to positivity in several cases was 4 to 8 hours earlier in specimen 1 (normal discard) than specimen 2.<br/><br/>Implications: This project challenges a specific component of a common clinical practice, withdrawal of laboratory specimens from CVCs. Given the significant variability among pediatric/oncology centers as to using or not using first withdrawn CVC blood specimen for cultures in children, evidence is needed to establish practice recommendations. Given that the pilot study demonstrates that the normally discarded specimen has been equivalent to care&ucirc;as-usual, this study may lend support to the practice of decreasing amount of blood necessary for accurate blood cultures. Further, the unexpected finding of earlier positivity provides the opportunity to provide definitive antimicrobial care sooner. Additional study with a larger population is necessary to verify these results.<br/></td></tr></table>en_GB
dc.date.available2011-10-27T10:27:31Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:27:31Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
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