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Blood cultures from peripheral IV cannula versus dedicated

venepuncture
Report By: Daniel P. Edgcumbe - SHO, Emergency Medicine
Search checked by Duncan McAuley - Consultant in Emergency Medicine
Institution: Addenbrooke's Hospital, Cambridge
Date Submitted: 6th July 2007
Last Modified: 8th October 2007
Status: Blue (submitted but not checked)

Three Part Question

In [patients presenting to the Emergency Department] does [taking blood cultures from freshly inserted
peripheral intravenous cannula rather than by dedicated venepuncture] result in [higher rates of
contamination]?

Clinical Scenario
Your hospital has a policy which states that blood cultures should be taken by dedicated venepuncture, rather
than from freshly inserted intravenous cannulae, in order to reduce the risk of contamination. You wonder if
this is supported by the literature.

Search Strategy
Medline 1950-07/07 using the DIALOG interface.
[culture] AND [(cannula OR catheter)] AND [peripheral] AND [(contamination OR contaminated OR
contaminate)] AND [LG=EN]

Search Outcome
Altogether 102 papers were found, of which 4 helped to answer the question posed.

Relevant Paper(s)

Author, Study type

date and Patient group (level of Outcomes Key results Study Weaknesses
country evidence)
Ramsook 2,431 children, (age not Individual Contamination Higher in blood Patients on
C, et al. specified) cohort study rate drawn by IV antibiotics/immunocompromised not
2000 cannula vs. excluded. Aerobic culture only
USA venepuncture Different antisepsis protocols for
(45/1,295 = nurses and lab phlebotomists
3.4% vs.
22/1,0084 =

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Author, Study type

date and Patient group (level of Outcomes Key results Study Weaknesses
country evidence)
2.0%, chi-
square
p=0.043)
Isaacman 99 children under 18 Individual Contamination No difference Small numbers with only 2
DJ, years old, mean age 52.2 cohort study rate between IV contaminated cultures 1 from IV line
Karasic months, median 22.9 cannula samples and 1 from standard (the standard
RB. months; excluding and those from culture was from a child with complex
1990 patients who had received dedicated congenital heart disease). Nursing
USA antibiotics in previous 48 phlebotomy staff aware of study.
hours, significant skin (1/99 vs. 1/99).
disease,
immunodeficiency or
povidone-iodine
sensitivity. Two cultures
taken
Norberg A Study in two phases: first Observational Contamination Higher in IV There may have been more selective
et al. phase when cultures were study rate cannula group: ordering of blood cultures in the
2003 taken from freshly 191/2108; from second phase when physicians
USA inserted IV cannulae; dedicated realised that this would require
second phase when phlebotomy additional venepuncture, compared to
specimens taken by 56/2000, chi- the first phase when cultures were
dedicated venepuncture. square, taken from intravenous cannulae.
4,108 blood cultures; p<0.001.
2,108 from IV cannula;
2,000 from dedicated
phlebotomy. Patients with
indwelling devices
excluded from study.
Smart D All ED patients (940) Individual Contamination No significant 8% (76) of patients excluded for
et al. assessed as requiring cohort study rate difference 'protocol violations; - inadequate
1993 blood cultures (mean age between groups. documentation/antisepsis and
Australia 59 years) 286 needle incorrect technique (5)
change before
inoculation; 141 no
needle change before
inoculation; 437 by IV
cannula.

Clinical Bottom Line

Taking blood samples for culture from a freshly inserted IV cannula appears to be associated with higher rates
of contamination than when samples are taken by dedicated venepuncture. Additionally, in the papers we
looked at, there is no convincing evidence that the isolation of true pathogens is affected by collection method.

References

1. Ramsook C, Childers K, Cron SG, Nirken M. Comparison of blood-culture contamination rates in a

pediatric emergency room: newly inserted intravenous catheters versus venipuncture. 2000
Oct;21(10):649-51.
2. Isaacman DJ, Karasic RB. Utility of collecting blood cultures through newly inserted intravenous
catheters. 1990 Nov;9(11):815-8.
3. Norberg A, Christopher NC, Ramundo ML, Bower JR, Berman SA. Contamination rates of blood cultures
obtained by dedicated phlebotomy vs intravenous catheter. 2003 Feb 12;289(6):726-9.Click here to
read

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4. Smart D, Baggoley C, Head J, Noble D, Wetherall B, Gordon DL. Effect of needle changing and
intravenous cannula collection on blood culture contamination rates. 1993 Jul;22(7):1164-8.

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