Drawing Blood Cultures from Central Venous Catheters

Recommended Approach for Blood Culture Collection

The Infectious Diseases Society of America recommends collecting paired blood samples from both the catheter and a peripheral vein when catheter-related bloodstream infections (CRBSI) are suspected, with the same volume of blood obtained from each site 1, 2, 3
The American College of Physicians suggests obtaining the same volume of blood from each site to ensure accurate diagnosis of CRBSI 2
If peripheral access is impossible, the European Society of Clinical Microbiology and Infectious Diseases recommends drawing two blood samples at different times from two different catheter lumens 3, 4
Proper skin antisepsis with alcohol, alcoholic chlorhexidine (>0.5%), or tincture of iodine should be used before collection, as recommended by the Centers for Disease Control and Prevention 1, 5
Adequate drying time for the antiseptic should be allowed to prevent contamination, as suggested by the World Health Organization 2, 3

CRBSI is diagnosed when the same organism grows from both catheter and peripheral cultures with either quantitative blood cultures showing ≥3-fold higher colony count in the catheter sample compared to peripheral sample, or differential time to positivity (DTP) showing growth from catheter hub at least 2 hours before peripheral sample, according to the Clinical and Laboratory Standards Institute 1, 2

If there is exudate at the catheter exit site, a swab for culture and Gram staining should be collected, as recommended by the Infectious Diseases Society of America 2, 3
For suspected pulmonary artery catheter infection, the introducer tip should be cultured, according to the American Thoracic Society 6
Blood cultures should be obtained before starting antibiotic therapy, as suggested by the Infectious Diseases Society of America 1, 2
Collecting cultures from all catheter lumens is not recommended due to insufficient evidence, according to the European Society of Clinical Microbiology and Infectious Diseases 2, 3

Non-tunneled CVCs should not be routinely removed in patients with fever and mild to moderate disease, as recommended by the American Society for Parenteral and Enteral Nutrition 7
The catheter should be removed if there are evident signs of local infection, clinical sepsis, or positive paired blood cultures, according to the Infectious Diseases Society of America 7, 8
After catheter removal in patients with CRBSI, non-tunneled catheters may be reinserted after appropriate antimicrobial therapy has begun, as suggested by the American Society for Parenteral and Enteral Nutrition 7

Failing to collect paired samples from both catheter and peripheral sites should be avoided, as recommended by the Clinical and Laboratory Standards Institute 1
Using povidone-iodine instead of alcoholic chlorhexidine or alcohol for skin preparation should be avoided, according to the Centers for Disease Control and Prevention 1, 3
Not allowing adequate drying time for antiseptics should be avoided, as suggested by the World Health Organization 2, 3
Removing catheters unnecessarily based solely on positive cultures without considering clinical status should be avoided, according to the American Society for Parenteral and Enteral Nutrition 7