Blood Culture, PICU — Guidance for Blood Culture Sources — Clinical Pathway: ICU

Blood Culture in Patients with Fever (Non-Oncology/Non-Neutropenic) Clinical Pathway — PICU

Guidance for Blood Culture Sources

There is limited data describing the ideal source for blood cultures. There is some evidence that yield is increased by obtaining a peripheral blood culture in addition to a CVL culture if one is present. The source of blood culture(s) should be determined by the clinical team and is guided by specific clinical scenarios. Antibiotics should not be delayed if unable to obtain a culture. The table below outlines the preferred lumen or line(s) that should be used if the decision is made to obtain a blood culture. In general, the PICU preference is as follows:

Access Culture Guidance Comments
Central Venous Line (CVL)
  • New Fever
    • 1 peripheral culture*
    • AND
    • 1 central culture from 1 lumen
  • Persistent Fever
    • 1 peripheral culture*
    • OR
    • 1 central culture from 1 lumen
  • *If a peripheral culture cannot be obtained or doing so would delay antibiotic administration, only send a central line culture. If a central line culture cannot be obtained, do not delay antibiotic start/change.
  • Cultures from all lumens may not always be necessary. Lines/ports that are not accessed should not be accessed solely to obtain a blood culture unless there is clinical suspicion that it is the source of fever or unable to obtain blood in any other manner.
  • Scenarios in which cultures from multiple lumens may be indicated:
    • Prolonged fevers without source where all lumens have not previously been cultured
    • Known bloodstream infection(s) where salvaging the CVL is the goal.
  • If all lumens contain infusions that should not be interrupted (e.g., vasoactives, sedation, paralytic), clinical team decision to determine best location for culture.
  • See specific guidance for patients with central venous lines and fever
Arterial Line
  • Patient with CVL
    • Follow CVL guidance above
  • Patient without CVL
    • 1 peripheral culture*
  • *If a peripheral culture cannot be obtained after 2 attempts, the patient does not have a CVL, or specimen can’t be accessed from CVL, obtain a culture from arterial line.
  • If suspected to be the source of the fever or infectious symptoms (such as purulence at site of catheter):
    • Discuss catheter removal with PICU fellow or Attending Physician if appropriate for patient’s overall status
No CVL or Arterial Line
  • Obtain 1 peripheral blood culture
  • A blood culture can be obtained with new PIV placement. Skin should be prepped with ChloraPrep™ before drawing a peripheral culture.
  • DO NOT obtain from an existing blood drawing PIV.

 

Fever Temperature ≥ 38.5°C
New fever Patient was afebrile in the preceding 48 hours, but now has a fever ≥ 38.5°C
Persistent fever Patient was febrile in the preceding 48 hours, and now has a fever ≥ 38.5°C

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