Culture of PICC Tip – Question Presented

Recently a vascular access team member sent us the following question:

Q. Do you culture the tip of a PICC in a patient who has (a) a suspected infection or (b) a patient who has positive blood cultures?

A. (Answer provided by Nancy Moureau, BSN, RN, CRNI. CPUI, VA-BC)

The purpose of culturing the tip of the catheter is to determine whether or not the catheter is infected. This practice has mixed ratings mainly because of the varying ways in which the catheter tip is rolled out and cultured, and due to the high contamination rate. The guidelines encourage blood cultures with time to positivity rather than tip culture. For blood cultures drawn on suspected patient take one set peripherally and one through the catheter both drawn within 15 minutes of each other. Time to positivity will demonstrate whether the catheter culture grows a significant amount of bacteria of a certain type prior to the peripheral culture. In this way we can see if the catheter is infected prior to removal of the catheter. If blood cultures come back positive then a tip culture can be taken, but really it is added cost that may not be necessary. Many hospitals are no longer doing any tip cultures. I refer you to the writings of Dr. Leonard Mermel, the CDC Guidelines 2011 and the NHSN National Health and Safety Network definitions and recommendations.

I hope this information is helpful to you in your practice and please continue to look up the references to back up any change in practice!


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