scholarly journals Blood Culture Collection through Peripheral Intravenous Catheters Increases the Risk of Specimen Contamination among Adult Emergency Department Patients

2012 ◽  
Vol 33 (5) ◽  
pp. 524-526 ◽  
Author(s):  
Wesley H. Self ◽  
Theodore Speroff ◽  
Candace D. McNaughton ◽  
Patty W. Wright ◽  
Geraldine Miller ◽  
...  
Keyword(s):  
Emergency Department ◽  
Relative Risk ◽  
Blood Culture ◽  
Confidence Interval ◽  
Culture Collection ◽  
Blood Cultures ◽  
Intravenous Catheter ◽  
Peripheral Intravenous Catheter ◽  
Emergency Department Patients ◽  
Intravenous Catheters

Five hundred five blood cultures collected through a peripheral intravenous catheter (PIV) in an emergency department were matched to cultures obtained by dedicated venipuncture from the same patient within 10 minutes. The relative risk of contamination for cultures collected through PIVs compared with dedicated venipuncture was 1.83 (95% confidence interval, 1.08–3.11).

scholarly journals Ultrasonography-guided peripheral intravenous catheter in emergency department patients with difficult access

2011 ◽  
Vol 1 (2) ◽  
pp. 170
Author(s):  
Luciano Santana-Cabrera ◽  
Sergio Martínez-Cuéllar ◽  
Guillermo Pérez-Acosta ◽  
Manuel Sánchez-Palacios
Keyword(s):  
Emergency Department ◽  
Intravenous Catheter ◽  
Peripheral Intravenous Catheter ◽  
Emergency Department Patients

The incidence and risk of infusion phlebitis with peripheral intravenous catheters: A meta-analysis

2019 ◽  
Vol 21 (3) ◽  
pp. 342-349 ◽  
Author(s):  
Luyu Lv ◽  
Jiaqian Zhang
Keyword(s):  
Risk Factors ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Meta Analysis ◽  
Female Gender ◽  
Incidence Rates ◽  
Intravenous Catheter ◽  
Peripheral Intravenous Catheter ◽  
Meta Analyses ◽  
Intravenous Catheters

Introduction: Phlebitis is a common complication associated with the use of peripheral intravenous catheters. The aim of this study was to estimate the incidence of phlebitis with peripheral intravenous catheter use and to identify risk factors for phlebitis development. Method: Literature survey was conducted in electronic databases (CINAHL, Embase, Google Scholar, Ovid, and PubMed), and studies were included if they used peripheral intravenous catheter for therapeutic or volumetric infusion and reported phlebitis incidence rates. Random effects meta-analyses were performed to obtain overall and subgroup phlebitis incidence rates and odds ratio between males and females in phlebitis incidence. Results: Thirty-five studies were included (20,697 catheters used for 15,791 patients; age 57.1 years (95% confidence interval: 55.0, 59.2); 53.9% males (95% confidence interval: 42.3, 65.5)). Incidence of phlebitis was 30.7 per 100 catheters (95% confidence interval: 27.2, 34.2). Incidence of severe phlebitis was 3.6% (95% confidence interval: 2.7%, 4.6%). Incidence of phlebitis was higher in non-intervened (30% (95% confidence interval: 27%, 33%)) than in intervened (21% (95% confidence interval: 15%, 27%)) groups, and with Teflon (33% (95% confidence interval: 25%, 41%)) than Vialon (27% (95% confidence interval: 21%, 32%)) cannula use. Odds of developing phlebitis was significantly higher in females (odds ratio = 1.42 (95% confidence interval: 1.05, 1.93); p = 0.02). Longer dwelling time, antibiotics infusion, female gender, forearm insertion, infectious disease, and Teflon catheter are important risk factors for phlebitis development identified by the included studies. Conclusion: Incidence of phlebitis with the use of peripheral intravenous catheters during infusion is 31%. Severe phlebitis develops in 4% of all patients. Risk of phlebitis development can be reduced by adapting appropriate interventions.

scholarly journals LO47: Use of C-reactive protein can safely decrease the number of emergency department patients with sepsis who require blood cultures

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S44
Author(s):  
R. Stenstrom ◽  
J. Choi ◽  
E. Grafstein ◽  
T. Kawano ◽  
D. Sweet ◽  
...  
Keyword(s):  
Emergency Department ◽  
Blood Culture ◽  
Positive Blood Culture ◽  
False Positive ◽  
Blood Cultures ◽  
Low Risk ◽  
Reactive Protein ◽  
Emergency Department Patients ◽  
Multicenter Prospective Cohort Study ◽  
Multicenter Prospective Cohort

Introduction: Sepsis protocols call for the acquisition of blood cultures in septic emergency department (ED) patients.However, the criteria for blood cultures are vague, they are costly, only positive 8-12% of the time, with up to half of these being false positives. The objective of this study was to establish if positive blood cultures could be excluded in low-risk sepsis patients with levels of CRP below 20 ml/L. Methods: This was a multicenter prospective cohort study of 765 ED patients at St Paul’s and Mount St Joseph’s hospitals in Vancouver with sepsis (2 or more SIRS criteria and infection) and none of: immuncompromised, injection drug use, indwelling vascular device or septic shock (SBP<90 mmhg). Consecutive patients with sepsis had CRP and blood cultures obtained at the same time.OUTCOMES. True positive blood cultures, false positive blood cultures, positive blood cultures that changed patient management. True and false positive blood cultures were based on Infectious Disease Society of America Guidelines, and change in management was defined as change in type or length of antibiotic therapy and was blindly adjudicated by a medical microbiologist. Results: 765 ED patients with sepsis met inclusion criteria. Mean age was 48.3 years and 57% were male. Blood cultures were positive in 99/765 (12.9%) subjects, of which 19 were false positive (19.2%). CRP was >20 mg/L in 595/765 (77.8%) of patients. Of 170 subjects with a CRP<20 mg/L, 3 had a positive blood culture (1.8%; 95% CI 0.1%- 5%). Management was not changed in any patient with a positive blood culture and CRP level<20 mg/L. Of 19 subjects with a false positive blood culture, CRP was <20 mg/L for 6 (31.6%). Conclusion: In this cohort of low-risk sepsis patients, based on a CRP of <20 mg/L, acquisition of blood cultures could be safely avoided in 22.2% of patients, at significant savings to the health care system.

scholarly journals Estimated Clinical and Economic Impact through Use of a Novel Blood Collection Device To Reduce Blood Culture Contamination in the Emergency Department: a Cost-Benefit Analysis

2018 ◽  
Vol 57 (1) ◽  
Author(s):  
Erik Skoglund ◽  
Casey J. Dempsey ◽  
Hua Chen ◽  
Kevin W. Garey
Keyword(s):  
Emergency Department ◽  
Blood Culture ◽  
Economic Impact ◽  
Hospital Costs ◽  
Cost Savings ◽  
Cost Benefit ◽  
Culture Collection ◽  
Blood Cultures ◽  
Hospital Length Of Stay ◽  
Decision Analysis Model

ABSTRACTBlood culture contamination results in increased hospital costs and exposure to antimicrobials. We evaluated the potential clinical and economic benefits of an initial specimen diversion device (ISDD) when routinely utilized for blood culture collection in the emergency department (ED) of a quaternary care medical center. A decision analysis model was created to identify the cost benefit of the use of the ISDD device in the ED. Probabilistic costs were determined from the published literature and the direct observation of pharmacy/microbiology staff. The primary outcome was the expected per-patient cost savings (microbiology, pharmacy, and indirect hospital costs) with the routine use of an ISDD from a hospital perspective. The indirect costs included those related to an increased hospital length of stay, additional procedures, adverse drug reactions, and hospital-acquired infections. Models were created to represent hospitals that routinely or do not routinely use rapid diagnostic tests (RDT) on positive blood cultures. The routine implementation of ISDD for blood culture collection in the ED was cost beneficial compared to conventional blood culture collection methods. When implemented in a hospital utilizing RDT with a baseline contamination rate of 6%, ISDD use was associated with a cost savings of $272 (3%) per blood culture in terms of overall hospital costs and $28 (5.4%) in direct-only costs. The main drivers of cost were baseline contamination rates and the duration of antibiotics given to patients with negative blood cultures. These findings support the routine use of ISDD during blood culture collection in the ED as a cost-beneficial strategy to reduce the clinical and economic impact of blood culture contamination in terms of microbiology, pharmacy, and wider indirect hospital impacts.

Comparison of Blood-Culture Contamination Rates in a Pediatric Emergency Room: Newly Inserted Intravenous Catheters Versus Venipuncture

2000 ◽  
Vol 21 (10) ◽  
pp. 649-651 ◽  
Author(s):  
Chris Ramsook ◽  
Kim Childers ◽  
Stanley G. Cron ◽  
Milton Nirken
Keyword(s):  
Blood Culture ◽  
Emergency Room ◽  
Pediatric Emergency ◽  
Optimal Choice ◽  
Blood Cultures ◽  
Contamination Rate ◽  
Intravenous Catheter ◽  
Antecubital Fossa ◽  
Intravenous Catheters

AbstractWe compared contamination rates of blood cultures obtained either from newly inserted intravenous catheters or via venipuncture. Of 2,431 blood cultures, the overall contamination rate was 2.7% (intravenous catheter, 3.4%; venipuncture, 2.0%;P=.043). The site of lowest contamination was the antecubital fossa, making this the optimal choice for blood-culture sampling.

Procedural competency for ultrasound-guided peripheral intravenous catheter insertion for nurses in a pediatric emergency department

2020 ◽  
pp. 112972982093713
Author(s):  
Carly Blick ◽  
Alexandra Vinograd ◽  
Jamie Chung ◽  
Elizabeth Nguyen ◽  
Mary Kate F Abbadessa ◽  
...  
Keyword(s):  
Emergency Department ◽  
Training Program ◽  
Success Rate ◽  
Training Period ◽  
Complication Rates ◽  
Initial Training ◽  
Ultrasound Guided ◽  
Intravenous Catheter ◽  
Peripheral Intravenous Catheter ◽  
Intravenous Catheters

Objectives: To evaluate if nurses can reliably perform ultrasound-guided peripheral intravenous catheter placement in children with a high success rate after an initial training period. A secondary aim was to analyze complication rates of ultrasound-guided peripheral intravenous catheters. Methods: A database recorded all ultrasound-guided peripheral intravenous catheter encounters in the emergency department from November 2013 to April 2019 including the emergency department nurse attempting placement, number of attempts, and whether it was successful. Patient electronic medical records were reviewed for the time of and reason for intravenous removal. The probabilities of first-attempt successful intravenous placement and complication at successive encounters after an initial training period were calculated. These probabilities were plotted versus encounter number to graph best-fit logarithmic regressions. Results: A total of 83 nurses completed a standardized training program in ultrasound-guided peripheral intravenous catheter placement including 10 supervised ultrasound-guided peripheral intravenous catheter placements. In total, 87% (3513/4053) of the ultrasound-guided peripheral intravenous catheter placed after the training program were successful on the first attempt. The probability of successfully placing an ultrasound-guided peripheral intravenous catheter increased as nurses had more experience placing ultrasound-guided peripheral intravenous catheters (R2 = 0.18) and was 83% at 10 encounters. Twenty-five percent (904/3646) of ultrasound-guided peripheral intravenous catheters had complications, and there was no statistically significant relationship between the number of encounters per nurse and complication rates (R2 < 0.001). Conclusion: Nurses can reliably place ultrasound-guided peripheral intravenous catheters at a high success rate after an initial training period. First-attempt success rates were high and increased from 67% to 83% for the first 10 unsupervised encounters after training and remained high. The complication rate was low and did not change as nurses gained more experience.

scholarly journals A Sterile Collection Bundle Intervention Reduces the Recovery of Bacteria from Neonatal Blood Culture

2018 ◽  
Vol 3 (1) ◽  
pp. 1-7 ◽  
Author(s):  
Linze F. Hamilton ◽  
Helen E. Gillett ◽  
Adam Smith-Collins ◽  
Jonathan W. Davis
Keyword(s):  
Intensive Care ◽  
Blood Culture ◽  
False Positive ◽  
Neonatal Intensive Care ◽  
Intervention Group ◽  
Group Versus ◽  
Antibiotic Use ◽  
Culture Collection ◽  
Blood Cultures ◽  
Before And After

Background: In neonatal intensive care, coagulase-negative Staphylococcus species can be both blood culture contaminants and pathogens. False-positive cultures can result in clinical uncertainty and unnecessary antibiotic use. Objective: This study sought to assess whether a sterile blood culture collection bundle would reduce the incidence of false-positive blood cultures in a regional neonatal intensive care unit. Method: Clinical data was collected from all infants who had blood cultures taken before and after the introduction of the sterile blood culture collection bundle intervention. This intervention required 2% chlorhexidine and full sterile precautions for blood culture collection. False-positive blood culture rates (presence of skin commensals and ≥3 clinical infection signs) were compared before and after the intervention. The number of days of unnecessary antibiotics associated with false-positive blood cultures was also analysed. Results: In the pre-intervention group (PRE) 197 cultures were taken from 161 babies. In the post-intervention group (POST) 170 cultures from 133 babies were acquired. Baseline demographics were similar in both groups. The rate of false-positive cultures in the PRE group versus the POST group was 9/197 (4.6%) compared to 1/170 (0.6%) (p < 0.05). Unnecessary antibiotic exposure was reduced in the PRE group in comparison to the POST group (27 vs. 0 days, p < 0.01). Conclusions: Implementation of sterile blood culture collection intervention reduced the number of false-positive results. This has potential benefit in reducing unnecessary antibiotic use.

scholarly journals Peripheral Intravenous Catheter Placement Is an Underrecognized Source of Staphylococcus aureus Bloodstream Infection

2016 ◽  
Vol 3 (2) ◽  
Author(s):  
Eloise D. Austin ◽  
Sean B. Sullivan ◽  
Susan Whittier ◽  
Franklin D. Lowy ◽  
Anne-Catrin Uhlemann
Keyword(s):  
Staphylococcus Aureus ◽  
Bloodstream Infection ◽  
Catheter Placement ◽  
Intravenous Catheter ◽  
Staphylococcus Aureus Bacteremia ◽  
Peripheral Intravenous Catheter ◽  
Life Threatening ◽  
Staphylococcus Aureus Bloodstream Infection ◽  
Life Threatening Complication ◽  
Intravenous Catheters

Abstract Few studies have focused on the risks of peripheral intravenous catheters (PIVs) as sources for Staphylococcus aureus bacteremia (SAB), a life-threatening complication. We identified 34 PIV-related infections (7.6%) in a cohort of 445 patients with SAB. Peripheral intravenous catheter-related SAB was associated with significantly longer bacteremia duration and thrombophlebitis at old PIV sites rather than current PIVs.

scholarly journals Identification of Potentially Unnecessary Micafungin Use Patterns: Opportunities for Antifungal Stewardship Interventions

2021 ◽  
Vol 1 (S1) ◽  
pp. s32-s33
Author(s):  
Miguel Chavez Concha ◽  
Kevin Hsueh ◽  
Michael Durkin ◽  
Andrej Spec
Keyword(s):  
Blood Culture ◽  
Urine Culture ◽  
Tracheal Aspirate ◽  
Culture Collection ◽  
Blood Cultures ◽  
Urine Specimen ◽  
Antifungal Stewardship ◽  
Microbiological Test ◽  
First Line Therapy ◽  
Patterns Of Use

Background: Echinocandins are used as first-line therapy for suspected and confirmed Candida spp, and its indiscriminate use may drive selection for echinocandin resistance. We evaluated patterns of use of micafungin to identify opportunities for antifungal stewardship. Methods: We identified all micafungin completed orders and microbiological test result data from July 2018 to November 2020 among hospitalized patients in Barnes-Jewish Hospital. Continuous micafungin courses with <48 hours of interruption were considered independent courses. We evaluated micafungin use in 3 scenarios in which its use may be unnecessary: (1) patients with blood cultures negative for Candida spp, (2) patients with recovery of yeast or Candida spp from tracheal aspirates, and (3) patients with recovery of yeast or Candida spp from urine cultures. We only included micafungin courses if they were initiated within 5 days of blood culture collection or up to 4 days after tracheal or urine culture collection to account for incubation and decision to initiate treatment. Results: We found 3,381 micafungin courses in 3,287 admissions. Of these, 2,532 courses had blood culture collection around micafungin initiation and were included in the first analysis: 1,879 (74%) were negative, 149 (6%) had Candida spp isolated in the blood, and 504 (20%) had positive blood cultures for other organisms. Micafungin was given for a median duration of 3 days (IQR, 2–7) to those with negative blood cultures and for 3 days (IQR, 1–5) to those with positive blood cultures without candidemia (p < 0.001), and prolonged durations of more than 5 days was seen in 768/1879 (41%) and 143/504 (28%) of courses, respectively (p <0.001). A total of 487 micafungin courses were initiated after tracheal aspirate culture collection. Those with yeast isolated (n = 100, 21%) received similar micafungin duration compared to those that had no yeast isolated [3 (2-7 IQR) vs. 3 (2-7) days, respectively; p = 0.56). Finally, a total of 844 micafungin courses started after urine culture collection. A total of 49 (6%) had yeast isolated from the urine and treatment duration was similar to those that did not [3 (1-6 IQR) vs. 3 (2-6) days, respectively; p = 0.87). Conclusions: Echinocandin treatment courses did not differ when a yeast was identified from a tracheal isolate or urine specimen. However, a substantial proportion of treatment courses were prolonged in those with negative Candida spp in the blood, suggesting opportunities for antifungal stewardship interventions.Funding: NoDisclosures: None

scholarly journals Neither Blood Culture Positivity nor Time to Positivity is Associated with Mortality among Patients Presenting with Severe Manifestations of Sepsis: The FABLED Cohort Study

2021 ◽  
Author(s):  
Katryn Paquette ◽  
David Sweet ◽  
Robert Stenstrom ◽  
Sarah N Stabler ◽  
Alexander Lawandi ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
Blood Culture ◽  
Blood Cultures ◽  
Cell Counts ◽  
Culture Positivity ◽  
Time To Positivity ◽  
Blood Culture Positivity ◽  
Normal White Blood Cell ◽  
Support Fund

Abstract Background Sepsis is a leading cause of morbidity, mortality, and health care costs worldwide. Methods We conducted a multi-center, prospective cohort study evaluating the yield of blood cultures drawn before and after empiric antimicrobial administration among adults presenting to the emergency department with severe manifestations of sepsis (ClinicalTrials.gov: NCT01867905). Enrolled patients who had the requisite blood cultures drawn were followed for 90 days. We explored the independent association between blood culture positivity and its time to positivity in relation to 90-day mortality. Findings 325 participants were enrolled; 90-day mortality among the 315 subjects followed-up was 25·4% (80/315). Mortality was associated with age (mean age in those who died was 72·5 ±15·8 vs. 62·9 ±17·7 years among survivors, p&lt;0·0001), greater Charlson Comorbidity Index (2 (IQR 1,3) vs. 1 (IQR 0,3), p=0·008), dementia (13/80 (16·2%) vs. 18/235 (7·7%), p=0·03), cancer (27/80 (33·8%) vs. 47/235 (20·0%), p=0·015), positive qSOFA score (57/80 (71·2%) vs. 129/235 (54·9%), p=0·009), and normal white blood cell counts (25/80 (31·2%) vs. 42/235 (17·9%), p=0·02). The presence of bacteremia, persistent bacteremia after antimicrobial infusion, and shorter time to blood culture positivity were not associated with mortality. Neither the source of infection nor pathogen affected mortality. Interpretation Although severe sepsis is an inflammatory condition triggered by infection, its 90-day survival is not influenced by blood culture positivity nor its time to positivity. Funding Vancouver Coastal Health; St-Paul’s Hospital Foundation Emergency Department Support Fund; the Fonds de Recherche Santé – Québec (CPY); Intramural Research Program of the NIH, Clinical Center (AL); the Maricopa Medical Foundation

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