12 Catheter Tip

CENTRAL LABORATORY, PANIMALAR MEDICAL COLLEGE HOSPITAL &
RESEARCH INSTITUTE
Department Microbiology - Bacteriology
Subject Standard Operating Procedures
Document Title SOP for Catheter Tip Culture
Document No CL-PMCHRI /MICRO/SOP/12
Issue No Issue Date Amendment No Amendment Date Page No
01 01.08.2022 00 - Page 1 of 6
1.0 PURPOSE & SCOPE OF THE EXAMINATION:

The purpose and scope of this SOP is to describe procedure for culture of intravenous
catheters, intravascular (intra-arterial or intravenous) catheter insertions, that cause a break
in the skin barrier and amenable to cause infection. This SOP is applicable for analysis of
central catheter infection in microbiology department.
2.0 RESPONSIBILITY:
It is the responsibility of all the Lab technicians to comply this SOP. Laboratory Manager
shall ensure implementation. QA department shall monitor compliance to the same.
3.0 DEFINITIONS & ABBREVIATIONS:
 Culture: Process of growing bacteria on the culture media.
 Sensitivity: Sensitivity of the isolates towards antimicrobial agents
 AST-Antibiotic Susceptibility Testing.
 SOP: Standard Operating Procedure.
 QA: Quality Assurance.
4.0 METHOD USED FOR EXAMINATION
Method: Aerobic Culture
5.0 PRIMARY SAMPLE COLLECTION:

Primary Sample Collection: Catheter tip from intravenous catheter
Sample collection:
5.1 Clean the skin with spirit prior to catheter removal.
Prepared by: Reviewed by : Lab Director Approved by: Vice Principal, Head &
Deputy Quality Manager Quality Manager Dr.Prathiba.A CEO
Dr.Shifa Meharaj S.H Ms. Saranya.S Dr. Surapaneni Krishna Mohan
RESEARCH INSTITUTE
01 01.08.2022 00 - Page 2 of 6
5.2 Observing aseptic technique, hold the exposed end of the catheter and carefully remove the
catheter from the patient with a sterile instrument, taking care to avoid contact with exposed
skin. Holding the distal end over a sterile container, cut the tip with a sterile scissors, dropping
the last 2 to 3 inches into the container.
5.3 Avoid drying by sealing the tube and submit to the laboratory as soon as possible.
5.4 It is advisable to collect two blood cultures, one through the catheter and one from a
peripheral site at the time the catheter is submitted for culture
 Shipment condition: Transport the specimens at room temperature

within 2 hrs
 Sample Rejection /criteria:
i. Samples received in unsterile container.
ii. Samples not meeting transportation conditions
iii. No TRF / Grossly incomplete TRF / Errors in labeling*
 Do not accept urinary Foley's catheter tips, chest tube tips.
 Catheter tips should not be placed in saline or transport medium.
 Smears from catheter tips, add little to the diagnosis of catheter-related sepsis.
 Submit catheter tips for culture only if there are signs of infection, i.e., inflammation at
the insertion site
RESEARCH INSTITUTE
01 01.08.2022 00 - Page 3 of 6
Note: Incomplete TRF details or labeling errors are clarified with physician before sample
acceptance / processing. If critical information is still not obtained the sample is rejected.
Details of samples rejected should be recorded in ‘Sample Rejection Log’.
6.0 REQUIRED EQUIPMENT AND REAGENTS:
 Equipment: Autoclave, incubator, biosafety cabinet, microscope, calibrated loop,
Bunsen burner
 Reagents required: Blood agar, Chocolate agar, MacConkey agar plates, Thioglycollate
broth, Oxidase reagent, Catalase test
Additional Requirements: Petri plates, glass slides, gloves, face masks, dropper, and
marker.
7.0 SAFETY PRECAUTIONS

 Basic safety rules commonly followed in clinical microbiology laboratories
generally suffice to protect laboratory workers.
 Do not use procedures which encourage aerosol formation.
 Observe all precautions as for handling any biological specimen.
 Wear face mask, apron and disposable gloves, while transferring and handling
the specimen.
 Clean laboratory benches with a good disinfectant containing detergent.
8.0 CALIBRATION PROCEDURE: NA
RESEARCH INSTITUTE
01 01.08.2022 00 - Page 4 of 6
9.0 PROCEDURAL STEPS

Quality Control:
The culture media and reagents must be checked for their quality and sterility for
every kit and batch. For further information, refer to SOP for Media Preparation and
QC.
Procedure:
Semi quantitative method
 Using a sterile forceps, remove catheter tip from transport tube.
 Lay catheter tip on a blood agar plate.
 Roll the tip back and forth across the entire surface of a blood agar and chocolate
Agar, Mac Conkey agar plates using sterile forceps and exerting slight downward
pressure and inoculate into thioglycollate broth.
 If the tip is too long, using sterile scissors, cut the end closest to the top of the tube
(proximal end) prior to rolling on the plates
 Incubate plates at 370C in CO2.
 Read the semi quantitative plates at 24 and 48 hours
 Count each type of colony isolated, comparing growth on each medium.
 Enumerate the growth on the Blood Agar
 Identify the organism by performing Vitek 2 Compact from vascular catheter tips with
colony counts of >15 CFU, including Gram-positive rods.
 For counts of < 15 CFU, identify only significant pathogens (e.g., Candida albicans,
Group A Streptococci, and Gram-negative rods.
 Report the sensitivity pattern as sensitive, intermediate, resistant.
RESEARCH INSTITUTE
01 01.08.2022 00 - Page 5 of 6
10.0 PERFORMANCE CHARACTERISTICS: NA

11.0 INTERFERENCES AND CROSS REACTIONS:
Procedure must be performed in a complete aseptic and sterile condition failing which
media can get contaminated by other contaminants effecting quality of results.
12.0 BIOLOGICAL REFERENCE INTERVALS: NA
13.0 ALERT/CRITICAL VALUES: NA
14.0 LABORATORY CLINICAL INTERPRETATION
 If culture positive, report as organism isolated, specifying the species. Provide
the antibiotic sensitivity pattern to the clinician.
 If negative, report as no growth, mentioning the days of incubation.
15.0 POTENTIAL SOURCE OF VARIATION: NA
16.0 REFERENCES:
a. District Laboratory Practices in Tropical Countries by Monica Cheesbrough-Part-
II.
b. Practical medical microbiology by Mackie and McCartney 14 th edition , page no
84 -90
c. Meyer’s and Koshi’s Manual of Diagnostic procedures in Medical Microbiology
and immunology/ serology CMC Vellore – Revised Edition :2001, page no 57 -62
d. Medical laboratory technology by Kanai L. Mukherjee Volume ii,14 th Edition,
page no 589-593
RESEARCH INSTITUTE
01 01.08.2022 00 - Page 6 of 6
e. Basic laboratory procedures in clinical bacteriology, WHO GENEVA, 1991, page

no 62-71
f. Monica Cheesebrough part 2 second edition,2002,page 124 -130
g. ASM Guidelines on Catheter tip culture.\\\\\\\\\\\\\\\\

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CENTRAL LABORATORY, PANIMALAR MEDICAL COLLEGE HOSPITAL &

1.0 PURPOSE & SCOPE OF THE EXAMINATION:

5.0 PRIMARY SAMPLE COLLECTION:

 Shipment condition: Transport the specimens at room temperature

7.0 SAFETY PRECAUTIONS

8.0 CALIBRATION PROCEDURE: NA

9.0 PROCEDURAL STEPS

10.0 PERFORMANCE CHARACTERISTICS: NA

15.0 POTENTIAL SOURCE OF VARIATION: NA

e. Basic laboratory procedures in clinical bacteriology, WHO GENEVA, 1991, page

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