Years ago, exchange over a wire was used as an infection control measure. That proved to be a bad method as it did not reduce the rate of CRBSI. Overwire exchange can be done for issues of catheter damage but there is a greater risk of infection. First the catheter will have biofilm on the internal lumen. This could break off when you advance the wire into the lumen. Second, the external catheter hub is far from being sterile but you must perform a sterile procedure with this external catheter. You could retract the catheter and amputate the external portion, allowing the retracted portion to lay on a sterile towel. But then you would have a piece of catheter that can easily get away from you and embolize. I am not aware of any publications on the actual rate of infection after this procedure is done. I have done it, but it is tricky and requires lots of skill and many hands to get it right. There are no recommendations for a specific time limit that I know of either. 

Lynn Hadaway, M.Ed., RN, BC, CRNI

www.hadawayassociates.com

I've been successful in introducing and trialing time to positivity in my institution. We are beginning early stages of data collection at this time.

On another note what about changing a PICC line over guidewire.  INS standards state it is ok if there is no signs of infection in your patient.  So are you guys in practice changing them over a guidewire? Do you have a time limit after intial placement? And if you are changing over guidewire then what is your infection rate?

Jamie Hamm

RN, BSN

At our 700+ bed hospital, they don't do time to positivity studies since it definitely would be more time-consuming. Unfortunately, we too are only left with the identified organism and not the official source. So we replace many lines when they probably weren't necessary. Our lab has no plans to ever do this.I would be interested to know how many organizations actually do this or if there is a study related to this issue? Cindy Hunchusky, RN, CRNI

It could be a variety of reasons including lack of money to fund a sales force or resistance from infectious disease physicians or anything in between.  Most small companies are funded by venture capitalist. Since the flow of money has dried up, many small companies trying to raise operating capital will have a difficult if not impossible time. Just my guess though.

Lynn Hadaway, M.Ed., RN, BC, CRNI

www.hadawayassociates.com

Why is the Endoluminal Brush not being more vigorously marketed?????? 

"FDA-approved FACTS (Fibrin Analysis Catheter Testing System) procedure offers a simple and economical way to test a CVC for sepsis while it remains in-situ, preventing the unnecessary removal and replacement of CVCs thus reducing costs and improving patient outcomes"

Taken from the followig Web site:  www.crsmedical.com  

Honestly, I don't think that they do many quantative looks at cultures.  I need clarification from the lab manager. 

Thanks for the reference, Lynn.  I will review that article again.

Gwen

Tip culture requires sacrificing the catheter and it may not be the cause of an infection. Before a line is removed, I would want to have blood cultures drawn from the catheter and another site. Then measure by colony count or time to positivity. If you can not do quantitive cultures, then time to positivity is what you are left with, but this also requires some special lab processes. So all you have to rely upon is qualitative cultures which only identifies the organism and does not provide any CFU information?

Lynn Hadaway, M.Ed., RN, BC, CRNI

www.hadawayassociates.com

I have a question.  If your lab doesn't do quantitive cultures, is tip culture still advisable?

Gwen Irwin

Austin, Texas

Here is the basis for your evidence:

Mermel, L., B. Farr, R. Sherertz, I. Raad, N. O'Grady, J. Harris, and D. Craven, 2001, Guidelines for the management of intravascular catheter-related infections: Journal of Infusion Nursing, v. 24, p. 180-205.
 

Lynn Hadaway, M.Ed., RN, BC, CRNI

www.hadawayassociates.com