Placing PICC line with positive blood cultures

Is it Safe to Place a Peripherally Inserted Central

  1. Individuals with positive blood cultures were placed in the positive blood culture group; individuals with negative blood cultures were placed in the negative blood culture group. In addition, the results of blood cultures performed during or after PICC line removal were obtained
  2. For example, suppose a patient has a PICC placed on June 1stand then they become febrile on June 3rd. The patient's blood is cultured while the PICC remains in place. The cultures are positive for Staphylococcus aureus
  3. Growth of the same organism from catheter tip culture • (>15 CFU per catheter segment if semiquantitative, >100 CFUs if quantitative culture) OR. If 2 simultaneous blood samples were drawn (one from a catheter and one from a peripheral vein): • CFU count from catheter sx > 3x greater than CFU from peripheral cx (quantitative cultures) OR
  4. Positive blood cultures are a relative but not absolute contraindication for a PICC,so you need to look further into the situation and weigh the risks and benefits of both placing and not placing the line
  5. ant and should not be treated. Preferred Criteria for CR-BSI
  6. For blood cultures from a PICC, mediport, or other central line you draw back and use that sample, no flushing, no wasting. This is the only blood sample you take without a flush and waste. Your instinct was correct
  7. Background: The use of peripherally inserted central catheter (PICC) lines has steadily grown in hospitalsettings. We investigated the factors associated with positive blood cultures after PICC line insertion. We alsoassessed whether pre-PICC blood culture status affects post-insertion blood stream infection (BSI)

Patients with PICC lines were enrolled in the study if a positive blood culture necessitated the removal of the PICC and subsequent culture of the PICC tip. A comparison was conducted between patients with positive and negative PICC cultures. Results: Thirty patients were included, four of whom had a positive PICC culture In a study of differential time to positivity, a definite diagnosis of catheter-related bacteremia could be made in 16 of the 17 patients who had a positive result of culture of a blood sample from the CVC at least 2 h earlier than they had a positive result of a peripheral blood culture; the overall sensitivity was 91% and specificity was 94%.

prior to each PICC access. 3. Aspirate the PICC for a positive blood return. 4. Prior to each Luer attachment, repeat the scrub of the needleless connector, and allow it to dry. 5. Flush with preservative-free 0.9% sodium chloride to clear the catheter of all blood residues. 6. Repeat the scrub of the needleless connector, and allow it to dry. 7 1.Requires 2 blood cultures drawn from separate sites, following skin disinfection with PI or CHG, within 48 hrs of each other. 2.The diagnosis of a laboratory confirmed (LC) catheter-associated BSI (CABSI) can only be made in the absence of another clinically appreciated infectious focus, the presence of one or more positive blood cultures The ID doc wants us to get blood cultures X2....a peripheral draw and a draw through the PICC. IF there is no growth, we can remove the PICC. Here's the thing....we NEVER draw anything off a single lumen PICC. She's already had to have cath flo once. If we draw off the PICC, screw up the line, and the blood cultures are positive, she'll need a. Trained nursing staff can place PICC lines at the bedside with ultrasound guidance, allowing quick central venous access placement in both ICUs and general medical ward. Blood cultures that remain positive > 72 hours of appropriate antimicrobial therapy

Number of positive culture sets. For true bacteraemias, multiple blood culture sets will usually grow the same organism . For patients with CVCs and a coagulase negative staph growing from different numbers of cultures, the positive predictive value was: 55% when one of one culture was positive, 20% when one of two cultures was positive The optimal duration of treatment and utility of follow-up blood cultures (FUBC) have not been studied in detail. Currently, the management of gram-negative bacteremia is determined by clinical judgment. To investigate the value of repeat blood cultures, we analyzed 500 episodes of bacteremia to determine frequency of FUBC and identify risk. If the patient has an intravenous catheter, the probability of true infection is increased, even with common skin contaminants. Table 3 lists the percentage by which some common bacteria can cause false positive blood cultures due to contamination. 2. When only one of the blood cultures is positive out of a set of 2 or more Positive blood cultures should flag within a 14 day window of the line tip being received i.e. seven days before or after line tip removal. If the patient has not had a positive blood culture in the seven days previous to receipt of the sample, it is fridged and reported as such

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ADULT BLOOD CULTURE GUIDELINE: Page 3 FREQUENTLY ASKED QUESTIONS 1. Most blood cultures come back negative - why bother taking them? Studies show that insufficient blood sample will return a negative result1,2,3.Therefore it is important to follow the procedure for taking blood cultures and collecting a sufficient blood sample Q&A PICC Line in active IVDU patient with track marks; Q&A Dwell time for midline catheters; Survey of USG PIV Practices: Recent Comments. nancyrene on Review and Case Studies of Midthigh Femoral Central Venous Catheter Placement; Dawn Counts on Review and Case Studies of Midthigh Femoral Central Venous Catheter Placemen The clinical and prognostic importance of positive blood cultures in adults. Am J Med 2010; 123:819. Weinstein MP, Towns ML, Quartey SM, et al. The clinical significance of positive blood cultures in the 1990s: a prospective comprehensive evaluation of the microbiology, epidemiology, and outcome of bacteremia and fungemia in adults A central line associated blood stream infection is a laboratory-confirmed bloodstream infection (BSI) in a patient who had a central line within the 48 hour period before the development of the BSI, and that is not related to an infection at another site. confirmation of CLABSI requires both a positive blood culture AND a collaborative. a confirmed positive blood culture with a PICC in place for 48 hours or longer without another iden-tified infection source, or if a PICC tip culture was positive in the setting of clinically suspected infec-tion. Catheter occlusion events were captured when documented in the medical record, or when tPA wa

Blood culture contamination is common, constituting up to half of all positive blood cultures at some institutions. The identity of the organism isolated can help in determining if the culture is contaminated, as some organisms rarely cause BSIs. The number of blood cultures that yield a particular organism can help predict true infections New Document Outlines Best Practices for Obtaining Blood Cultures . (not through a central line) to minimize the frequency of false positive results. , or Staph lugdunensis, there is no requirement to order a second blood culture as a test of cure. The PICC team will be aligning with these recommendations. If the primary team. Peripherally inserted central catheter complications are more likely when the ratio of catheter diameter to vein diameter increases. Inserting a 3-5 French catheter such as a PICC in an internal or external jugular vein is therefore less likely to cause vein damage than if the same device was installed in a narrower vein in the upper arm

If both culture sets are positive, there is less chance that contamination was the cause than if 2 positive blood cultures were collected from a single blood draw (in other words, collected using a vacutainer or via venipuncture and attaching multiple bottles after a single decontamination of the site), these specimens would be considered a. If the patient has an intravenous catheter, the probability of true infection is increased, even with common skin contaminants. Table 3 lists the percentage by which some common bacteria can cause false positive blood cultures due to contamination. 2. When only one of the blood cultures is positive out of a set of 2 or more A peripherally inserted central catheter (PICC) line is a minimally invasive way to deliver medications to the central venous blood system, usually inserted at the bedside by a specially trained nurse. In the past, a surgeon would have to insert a central line, but the advent of the PICC line has made these almost obsolete

ety of America, with continuing or recrudescent positive blood cultures with S. aureus in association with a posi-tive culture of the PICC tip after removal.11 The Australian Commission on Safety and Quality in Health Care catheter-associated BSI guidelines, defined as new positive blood cultures, in association with a central line in situ for. whether blood cultures have been obtained). [IB] - When infection is suspected, at least 2 sets of cultures should be drawn (aerobic & anaerobic). [IIB] - Blood cultures should be drawn from peripheral site and the central line if catheter infection is suspected [IB]. Blood cultures should not be drawn from central catheters routinely. [IIID. • Positive blood culture within two days of a positive line tip, or positive line tip within one week of a positive blood culture. Results Number of lines placed A total of 140 PICC lines were inserted over 12 months; one other PICC insertion was attempted but was not possible. This is an insertion success rate of 99.3%. All PICCs were place (3) Dysfunction of the line supports the diagnosis of line infection (this may be due to an infected thrombus occluding the line). blood cultures. Draw two sets of peripheral blood cultures (from different sites) and one set of cultures from the distal port of the line. All cultures should be obtained using the same volume of blood (e.g. 10 ml)

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BACKGROUNDPeripherally inserted central catheters (PICCs) are increasingly utilized. Patient and system factors that increase risk of complications should be identified to avoid preventable patient harm.METHODSA case control analysis of adult inpatients who underwent PICC placement from January 2009 to January 2010 at Scott & White Memorial Hospital was conducted to determine the incidence and. - Confirmed catheter-related local infection (LI) was defined as a positive culture of the PICC segment (≥10 3 CFU/ml) with pus emerging from the exit site or a tunnel infection, with local manifestations of infection but no general signs of sepsis and negative blood cultures Slide 30. C-VAD Line Cultures: Interpretation A catheter culture yield of ≥15 colony forming unit, accompanied by signs and/or symptoms of infection is consistent with a catheter-related infection. Do not give antibiotics based on a positive catheter culture only. Evaluate the clinical picture In the ICU if a patient didn't have positive blood cultures and long term central access was needed we would have a PICC placed. A lot of times we'd have an IJ CVC or maybe femoral depending on how emergent placement was and then change it over to a PICC as soon as we could based on the patients status Blood cultures are a key diagnostic test for intensive care unit (ICU) patients; however, contaminants complicate interpretations and lead to unnecessary antibiotic administration and costs. Indications for blood cultures and central venous catheter (CVC) insertions often overlap for ICU patients. Obtaining blood cultures under the strict sterile precautions utilized for CVC insertion might be.

How to draw blood cultures from a PICC line

If cultures grow two hours earlier in the catheter-tip blood than in the peripheral blood, the infection is probably related to the PICC line. The differential time to positivity is something that we think about, Dr. Zimmer said. This is something you can use on the spot when you are taking care of patients without being in a very sensitive lab Peripherally Inserted Central Catheter (PICC) o Benefits • Long-term access - dwell time varies (can be > one year) • Decreased length of stay in hospital -allows for IV therapy in non-acute settings, i.e., home care /hospice/ skilled nursing facility (SNF) • Cost effective compared to all other central VAD A 59 year old white male was transferred from an outside hospital with back pain, fever and neurological deficits and found to have an epidural abscess with MRSA positive blood cultures. Emergent debridement and drainage of abscess without complications was performed and a PICC line was inserted for long term antibiotics exact day of the positive blood culture, the patient must have ongoing signs/symptoms related to the primary infection at the time of the positive blood culture. If the documentation support that the primary infection has resolved (e.g., symptoms resolved), then a positive blood culture must not be reported as secondary to that resolved infection

o Use the smallest catheter to complete the therapeutic goal (generally 3Fr PICC line is used to obtain laboratory samples and give blood products). o Place PICC line in lower extremities, preferably left leg. Right leg is used for heart catheterization. o If there are issues or questions consult with cardiothoracic surgeon the position of PICC line, whereas in 26% cases, a 2nd X-ray was needed. 5-7% of the babies needed more than 2 X-rays for final confirmation of PICC line position following adjustment and fixing. Though true line associated infection occurred only in 7 cases, total of 63 neonates had a positive culture [blood/CSF/urine] 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 cultures are negative but the catheter culture is positive, antibiotics are generally not recommended, even for patients with valvular heart disease or immunosuppression. The exception is patients whose catheter tips grow S. aureus and have negative blood cultures. These patients should receive 5-7 days of antibiotics Guidelines for Interpretation of Positive Blood Cultures. Some clinical and laboratory tools can aid physicians and microbiologists in deciding whether a blood isolate is a pathogen or a contaminant. Obviously, the presence of predisposing factors and a consistent clinical presentation can help clinicians interpret test results. The identity of.

8. Some patients will require PICC placement using fluoroscopy in interventional radiology and this will be undertaken by the interventional radiology team in line with their own protocols. 7. Confirming PICC Tip Location. 1. If ECG technology has been used to place the PICC a print out of the ECG ca The second major complication due to the PICC insertion is the catheter related blood stream infection (CRBSI). The incidence of PICC-BSI in literature ranges from 2.0 per 1000 catheter days to 3.1 per 1000 catheter days. This disparity stems from the fact that there is no single definition of catheter infection Although venipuncture is the preferred method for obtaining blood cultures, specimens often are obtained from intravenous catheters (IVC). For IVC-drawn blood cultures, some authorities recommend discarding the initial 5 to 10 ml of blood to reduce contamination and remove potential inhibitory substances. To determine whether this practice reduced contamination rates (CR), we assessed the. Catheter salvage may be considered even after positive blood cultures are acquired May Be Appropriate Variant 10: Thrombotic complications. Adult or child ≥13 years of age. Chest port placed via right internal jugular vein is being used for chemotherapy. The infusion nurse can infuse saline but is unable to aspirate blood from the catheter

Enterococcus species in positive blood cultures represents true BSI, studies have found that Enterococcus species may be a contaminant in blood cultures in 10 -15 % of cases [ 3, 5]. It has beensuggestedthatasingleposit ivebloodcultureinthepresence of other negative blood cultures or co-isolation with skin organ Bacteremia as PDX when the Blood culture comes back as a contaminant. Scenario: Pt called back to the ED for a positive Bld Cx taken the day before. Patient admitted and put on I.V ABX. The re-culture comes back negative and the positive blood culture from the day before was deemed a contaminant. Abx stopped and the patient is discharged The CDC specified that PICC blood draw procedure should be as follows: Maintain aseptic technique when accessing the catheter as outlined. Remove the first 3 to 5 ml of blood and then discard. Obtain blood specimen. Flush the PICC line with a 10 to 20-ml normal saline. If necessary, clamp the catheter when flushing is complete Before placing a PICC (including guide-wire exchanges), the operator and any person who enters the sterile field to assist in the procedureshould use maximal barrier precautions including a cap, mask, sterile gown, sterile gloves, and a sterile full body drape NurseyBaby'05, BSN, RN. Specializes in Neuro/Med-Surg/Oncology. The clotted line can be treated with Cathflow, if necessary. Also, when you waste the first 10mL of blood and flush with 10-20 mL of NS, any blood with the immedialy infused meds/supplements should not be in with what you're sending to the lab

Cureus Correlation of Positive Blood Cultures with

Blood culture volume is essential. There is a 3% increase in sensitivity for every extra mL collected. Blood culture bottles require 8- 10 mLs. to be accurate. After positive blood cultures have been identified wait at least 48 hours to draw any additional blood cultures. Surveillance blood cultures should not be routinely done As image intensification is rarely used in insertion of PICC Lines a chest x-ray must be performed before the line can be used. This will be checked by a doctor and the results recorded in-patients medical notes, prior to using the PICC line. The tip of the PICC line should lie within the superior vena cava (Philpot & Griffiths 2003) Blood cultures positive for S. aureus, coagulase-negative staphylococci, or Candida species in the absence of other sources of infection should increase the suspicion of catheter-related infection. Catheter cultures should be performed when a catheter is removed for suspected infection A PICC line gives your doctor access to the large central veins near the heart. It's generally used to give medications or liquid nutrition. A PICC line can help avoid the pain of frequent needle sticks and reduce the risk of irritation to the smaller veins in your arms.. A PICC line requires careful care and monitoring for complications, including infection and blood clots Blood cultures are used to detect bacteraemia in children and infants. The validity of results obtained is entirely dependent on specimen collection. Inaccuracies can lead to diagnostic and therapeutic difficulties. Contamination, or false positive blood cultures, can lead to inappropriate treatment, increased hospital stays and hospital.

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Guidelines for the Management of Intravascular Catheter

Blood Culture ; CBC; A positive Kernig's sign is when a patient has pain when the leg is extended while the hip is flexed at 90 degrees. From a nursing point of view one of the biggest challenges with these patients is trying to keep a working IV in place. Some kids end up needing a PICC line. Your priority nursing concepts are. Blood Cultures Drawn From Central vs Peripheral Lines: Does it Matter? Abstract & Commentary. Synopsis: This study of blood culture draw sites in febrile ICU patients found that it is safe and reliable to obtain at least 1 of the blood cultures from a central venous catheter, irrespective of the type of catheter in place. Source: Beutz M, et al. Clinical utility of blood cultures drawn from.

As soon as you get the test results back from the culture you have the okay to insert the picc line Ideal procedure to place a PICC involves manipulating the catheter centrally, with the goal being a final tip position in the superior vena cava (SVC) if placed from the head, neck or upper extremity and at junction of the inferior vena cava (IVC) and right atrium when placed from the lower extremity . Thus, the tip of an LL catheter should be. turbulence created will cleanse the internal lumen of the catheter more efficiently. A positive pressure flush takes place when the syringe is removed from the end of the PICC whilst still flushing - this is to close the valve to prevent blood reflux back into the catheter which could cause an occlusion

PICC-related BSI was confirmed in each case by demonstrating concordance between isolates colonizing the PICC at the time of removal and from blood cultures by restriction-fragment DNA subtyping. Results: Overall, 115 patients had 251 PICCs placed. Mean duration of catheterization was 11.3 days (total, 2,832 PICC-days); 42% of the patients were. Central venous catheter (CVC) tip cultures are useful in the assessment of a patient with a potential catheter-related bloodstream infection (CRBSI). However, these results can be misleading particularly in the absence of concomitant peripheral and central line blood cultures. Catheter tip cultures 2. Each lumen/line will allow for separate infusions through an individual lumen. Valved and non valved Catheters are either non-valved (open-ended) or valved. The valve is a pressure-sensitive slit that remains closed unless fluids are infused (positive pressure: valve opens outward) or blood is withdrawn (negative pressure: valve opens inward) There were no clinical signs or symptoms for metastatic infections. A PICC line was placed after blood cultures remained negative for 48 hours. The decision was made to treat him with four weeks of antibiotics from his last positive blood culture, with follow-up in ID clinic. Bottom Line. SAB is a common worldwide cause of morbidity and mortality Policies and Procedures: Central Venous Catheters - PICC, Short Term, Tunneled, I.D. #1042 Implanted - Blood Withdrawal Page 2 of 10 Peripherally Inserted Central Catheter (PICC): A central venous access device inserted into a peripheral vein whose tip dwells in the superior vena cava and is used in acute care, long term care or home care

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Blood cultures should be drawn because they are positive in over half of patients. and a PICC line should be in place for continuous antibiotic therapy Peripherally inserted central catheter A peripherally inserted central catheter (PICC) is a device inserted into a peripheral vein and threaded into the central venous circulation. Although PICC is the preferred term for this device, neonatal care pro-viders have historically referred to these catheters a upper extremity PICC: lower 1/2 to 1/3 of SVC or RA/SVC junction. 2,6,8,9. lower extremity PICC: IVC/ RA just above diaphragm. T8 -T10. 6,10 . If you are unable to get central tip location pull the line back outside of the thoracic cavity a use it as a midline. Manage the catheter as long peripheral IV rather than a central line. Owing to ease of insertion through peripheral veins of the upper extremity, peripherally inserted central catheter (PICC) use has become increasingly popular. Although the insertion route of PICCs avoids complications such as pneumothorax or injury to the vessels of the neck and chest, PICCs are associated with important complications [ 1 ]

Early use of peripherally inserted central catheters is

A midline catheter, as defined by the Infusion Nurses Society, is a venous catheter access device measuring 3-8 in (6-20 cm) with the distal tip in the basilic, brachial, or cephalic veins at or below the axillary fold, distal to the shoulder. 26 Difficult intravenous access (DIVA) was defined by Keyes in 1999 27 as 2 unsuccessful attempts, by. According to our hospital policies, diagnosis of CRBSI was established by the differential time to positivity method (blood culture from the catheter becoming positive at least 120 minutes before the peripheral blood culture) or by direct culture of the tip of the catheter, should the catheter be removed or replaced over guidewire (culture of.

The PICC can be used to give you special fluids, medications, blood products, to take blood samples for testing, or contrast power injections. Your doctor or nurse will explain the reasons why you have this type of catheter. The PICC is inserted by the nurse or doctor into a vein in your arm and threaded into a large vein that leads to your heart Catheter Blood Collection Practices, 18 th September 2018 Laboratory Prospective - Sample Contamination Blood Culture 'Blood cultures from indwelling intravascular access devices (VAD) such as intravenous catheters and ports are associated with greater contamination rates than from blood cultures obtained by venipuncture CABSI was defined as positive blood culture in a patient with PICC in situ when culture was taken minimum 24 h after catheter insertion up to maximum 48 h after catheter removal. Phlebitis was.

If a catheter cannot be removed, the permanent closure of unneeded lumens may reduce the risk of CRBSI. of central blood culture vs peripheral blood culture was > 120 min. CRBSI was defined as probable if at least one blood culture was positive with a recognized pathogen in the absence of another site of infection. Data were analyzed using. Central venous catheter (CVC) tip cultures are useful in the assessment of a patient with a potential catheter-related bloodstream infection (CRBSI). However, these results can be misleading particularly in the absence of concomitant peripheral and central line blood cultures. Catheter tip cultures should not be submitted to the laboratory unless CRBSI is suspected as the predictive value of. This group had a strong suspicion of catheter related bacteremias although only one bottle of cultures was positive. Patients with two positive blood culture bottles were 57 (25.9%) in group of CB and 13 (20%) in group of PB, without statistically significant differences p= 0.33 IC 95%( 5.9%: -5. 4% to 17. 2%) A peripherally inserted central catheter (PICC) is a tube, which is inserted into a vein in the upper arm, usually in the middle part. It is moved up into the large vein leading to your heart. A PICC can be placed in either arm. A PICC is made of a non-irritant material, for example, silicone, which mean Complications were recorded including leaking at the PICC insertion site, phlebitis (erythema, swelling, pain, or palpable cord), infection (positive blood and catheter tip cultures), catheter occlusion (inability to infuse or withdraw), and mechanical malfunction (catheter damage or unplanned catheter removal)

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Valved PICC: A valved PICC is a central venous catheter with a valve that is present at the distal or proximal tip. Valved PICCs require application of positive pressure (flushing or infusion) or negative pressure (aspiration) for fluid to move within the catheter. Clamping is not necessary; therefore, there are no clamps on a valved PICC. (See. Pediatric PICC Line Placement. A peripherally inserted central catheter (PICC line) is most often used to deliver medication over a long period. The doctor or nurse inserts the PICC line, which is a thin tube, into a vein in the arm. The tube is advanced until it reaches the superior vena cava, a vein that carries blood to the heart

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The American Society of Microbiology sets the maximum acceptable contamination rate at 3 percent. 7 This is an overall rate and includes blood cultures drawn by all methods and cultures positive because of colonization. Whether or not a more tolerant contamination rate should apply for cultures drawn from VADs is up to the facility • Place sterile towel as near as possible to the PICC catheter. Clean around the catheter exit site with a 2% Chlorhexidine impregnated applicator, and if a Securacath device has been used ensure that the PICC catheter is lifted up and down to allow for cleaning all around the exit site where the Securacath sits CLABSI is a diagnosis of exclusion or by differential time to positive blood cultures. In stable patients with suspected port infection, antibiotic salvage can be attempted. This consists of broad-spectrum intravenous antibiotics until a specific organism is determined on culture

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A peripherally inserted central catheter (PICC) or PIC line, is a form of intravenous access that can be used for a prolonged period of time. It is also called a percutaneous indwelling central catheter. Peripherally inserted central catheters are used to obtain central venous access. For example peripherally inserted central catheter may be. Midline Catheters: The midline catheter (i.e. long peripheral catheter) is an IV catheter placed into a peripheral vein, with the distal tip located just proximal to the axilla. Midline catheters can range from 10 to 25cm in length, have a single or double lumen, and placed with Seldinger's technique and ultrasonography infection requires positive blood cultures from both the CVC and peripheral blood or a positive exit-site swab. On advice from the microbiologist (guided by the clinical status of the patient) 48 hours of appropri-ate antimicrobial therapy can be adminis-tered via the CVC. If cultures are still posi-tive after this then the infection is unre Catheter Malposition: Malposition can occur during PICC insertion or later due to changes in pressure inside the chest or from catheter migration. After the insertion of catheter, the position of its tip is confirmed via x-ray. Confirmation of proper tip placement is required before using the device as a malpositioned catheter can caus • Blood cultures should be drawn from peripheral site. You do not want blood from the line, unless you are trying to rule out line sepsis. You want a fresh specimen, not a specimen that's been dwelling in the central line - When you are drawing blood cultures from the line to rule out line sepsis, make sure to cleanse Clave port wit