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Chapter 13.12 : Culture of Intravascular Devices

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Abstract:

Intravascular catheters are used to provide continuous vascular access to permit blood sampling; to administer blood products, medications, total parenteral nutrition, and other fluids; and, in the case of pulmonary artery catheters, to permit hemodynamic monitoring of cardiac function. Because these devices penetrate the integument, they put the patient at significant risk for development of device-related infection. The insertion site becomes colonized by bacteria from the patient's own skin or by microorganisms carried on the hands of medical personnel ( ). Organisms can also gain access through the lumen of the catheter following contamination of the hub ( ) or infusion of contaminated fluids. Invading organisms can then colonize the intravascular catheter surfaces in the form of a biofilm and produce local infection and, in a significant number of cases, bacteremia, fungemia, suppurative phlebitis, or septic thrombosis ( ). ( Appendix 13.12-1 for further discussion.)

Citation: Garcia L. 2010. Culture of Intravascular Devices, p 501-507. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch13.12
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Figures

Image of Figure 13.12-1
Figure 13.12-1

Placement of surgically implanted long percutaneous catheter (illustration by Carol Moretti).

Citation: Garcia L. 2010. Culture of Intravascular Devices, p 501-507. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch13.12
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Image of Figure 13.12-2
Figure 13.12-2

Placement of surgically implanted subcutaneous port (illustration by Carol Moretti).

Citation: Garcia L. 2010. Culture of Intravascular Devices, p 501-507. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch13.12
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Image of Figure 13.12-3
Figure 13.12-3

Segments of long catheter for culture (illustration by Carol Moretti).

Citation: Garcia L. 2010. Culture of Intravascular Devices, p 501-507. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch13.12
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Image of Figure 13.12-4
Figure 13.12-4

Segment of short catheter for culture (illustration by Carol Moretti).

Citation: Garcia L. 2010. Culture of Intravascular Devices, p 501-507. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch13.12
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Image of Figure 13.12-5
Figure 13.12-5

Maki roll technique (illustration by Carol Moretti)

Citation: Garcia L. 2010. Culture of Intravascular Devices, p 501-507. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch13.12
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References

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1. Cleri, D. J.,, M. L. Corrado,, and S. J. Seligman. 1980. Quantitative culture of intravenous catheters and other intravascular inserts. J. Infect. Dis. 141:781786.
2. Collignon, P. J.,, R. Chan,, and R. Munro. 1987. Rapid diagnosis of intravascular catheter-related sepsis. Arch. Intern. Med. 147:16091612.
3. Collignon, P. J.,, N. Soni,, I. Y. Pearson,, W. P. Woods,, R. Munro,, and T. C. Sorrell. 1986. Is semiquantitative culture of central vein catheter tips useful in the diagnosis of catheter-associated bacteremia? J. Clin. Microbiol. 24:532535.
4. Liñares, J.,, A. Sitges-Serra,, J. Garau,, J. L. Perez,, and R. Martin. 1985. Pathogenesis of catheter sepsis: a prospective study with quantitative and semiquantitative cultures of catheter hub and segments. J. Clin. Microbiol. 21:357360.
5. Maki, D. G., 1980. Sepsis associated with infusion therapy, p. 207253. In S. Karran (ed.), Controversies in Surgical Sepsis. Praeger, New York, NY.
6. Miller, K. B., 1988. Cardiovascular system update, p. 11681181. In R. Berg (ed.), The APIC Curriculum for Infection Control Practices, vol. 3. Kendall/Hunt, Dubuque, IA.
7. Moore, C. L.,, K. A. Erickson,, L. B. Yanes,, M. Franklin,, and L. Gonsalves. 1986. Nursing care and management of venous access ports. Oncol. Nurs. Forum 13:3539.
8. Raad, I.,, M. F. Sabbagh,, K. H. Rand,, and R. J. Sherertz. 1992. Quantitative tip culture methods and the diagnosis of central venous catheter-related infections. Diagn. Microbiol. Infect. Dis. 15:1320.
9. Raad, I.,, H. Hanna,, and D. Maki. 2007. Intravascular catheter-related infections: advances in diagnosis, prevention, and management. Lancet Infect. Dis. 7:645657.
10. Siegman-Igra, Y.,, A. M. Anglim,, D. E. Shapiro,, K. A. Adal,, B. A. Strain,, and B. M. Farr. 1997. Diagnosis of catheter-related bloodstream infections: a meta-analysis. J. Clin. Microbiol. 35:928936.
11. Collignon, P. J.,, and R. Munro. 1989. Laboratory diagnosis of intravascular catheter associated sepsis. Eur. J. Clin. Microbiol. Infect. Dis. 8:807814.
12. Coutleé, F.,, C. Lemieux,, and J. F. Paradis. 1988. Value of direct catheter staining in the diagnosis of intravascular-catheter-related infection. J. Clin. Microbiol. 26:10881090.
13. Hamory, B. H., 1987. Nosocomial bloodstream and intravascular device-related infections, p. 283319. In R. P. Wenzel (ed.), Prevention and Control of Nosocomial Infections, vol. 1. The Williams & Wilkins Co., Baltimore, MD.
14. Kristinsson, K. G.,, I. A. Burnett,, and R. C. Spencer. 1989. Evaluation of three methods for culturing long intravascular catheters. J. Hosp. Infect. 14:183191.
1. Cleri, D. J.,, M. L. Corrado,, and S. J. Seligman. 1980. Quantitative culture of intravenous catheters and other intravascular inserts. J. Infect. Dis. 141:781786.
2. Cooper, G. L.,, and C. C. Hopkins. 1985. Rapid diagnosis of intravascular catheter-associated infection by direct Gram staining of catheter segments. N. Engl. J. Med. 312:11421147.
3. Haslett, T. M.,, H. D. Isenberg,, E. Hilton,, V. Tucci,, B. G. Kay,, and E. M. Vellozzi. 1988. Microbiology of indwelling central intravascular catheters. J. Clin. Microbiol. 26:696701.
4. Liñares, J.,, A. Sitges-Serra,, J. Garan,, J. L. Perez,, and R. Martin. 1985. Pathogenesis of catheter sepsis: a prospective study with quantitative and semiquantitative cultures of catheter hub and segments. J. Clin. Microbiol. 21:357360.
5. Maki, D. G., 1980. Sepsis associated with infusion therapy, p. 207253. In S. Karran (ed.), Controversies in Surgical Sepsis. Praeger, New York, NY.
6. Maki, D. G., 1989. Pathogenesis, prevention, and management of infections due to intravascular devices used for infusion therapy, p. 161177. In A. L. Bisno, and F. A. Waldvogel (ed.), Infections Associated with Indwelling Medical Devices. American Society for Microbiology, Washington, DC.
7. Maki, D. G.,, C. E. Weise,, and H. W. Sarafin. 1977. A semiquantitative culture method for identifying intravenous-catheter-related infection. N. Engl. J. Med. 296:13051309.
8. Needham, P. M. 1990. Intraluminal colonization of a Groshong catheter. Clin. Microbiol. Newsl. 12:189190.
9. Rello, J.,, J. M. Gatell,, J. Almirall,, J. M. Campistol,, J. Gonzalez,, and J. Puig de la Bellacasa. 1989. Evaluation of culture techniques for identification of catheter-related infection in hemodialysis patients. Eur. J. Clin. Microbiol. Infect. Dis. 8:620622.
10. Zufferey, J.,, B. Rime,, P. Francioli,, and J. Bille. 1988. Simple method for rapid diagnosis of catheter-associated infection by direct acridine orange staining of catheter tips. J. Clin. Microbiol. 16:175176.

Tables

Generic image for table
Table 13.12-A1

Bloodstream pathogens suggestive of intravenous-infusion-related septicemia

Modified from reference .

Citation: Garcia L. 2010. Culture of Intravascular Devices, p 501-507. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch13.12

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