REVISION: 8/08
PROCEDURE APPROVED: 8/08
PROCEDURE FOR OBTAINING BLOOD CULTURES (B.C.)
The procedure for obtaining blood cultures from a central line will be followed by RN’s. The procedure for obtaining blood cultures from peripheral sites will be followed by RN’s or PCT’s. The same person should draw the complete set of blood cultures.
PURPOSE: To obtain blood without contaminating the specimen for identification and/or confirmation of causative organisms in bacteremia and septicemia.
EQUIPMENT: 2 sets of B.C. or 1 Isolator tube (to be drawn at the same time) = 4 bottles and one isolator tube.
**If applicable, refer to unit specific guidelines for obtaining blood cultures.
Tourniquet
2 Blood Culture Kits (available from Distribution Center/Central Supply) containing:
· Blood culture (skin) prep/Chloraprep
· Disposal bag
· Aerobic bottle
· Anaerobic bottle
· Blood culture bottle adapter (General verbiage)
Alcohol applicator
2 – 20ml syringe (30ml if blood cultures for Histoplasma also)
2 – Sterile needles or vacutainer blood culture adaptor with butterfly needle
1 – Isolator tube if culture for Histoplasma is ordered
Microbiology specimen sheet or Sunrise Transmittal slip
Patient Lab specimen labels
Gloves
KEYPOINT: Butterfly needle must
be used if using vacutainer adaptor. Do
not use straight vacutainer needle.
NURSING ACTION: Identify patient by comparing ID band to lab request. Determine sites and ports the cultures are to be obtained from. Wash hands with 2% CHG.
PROCEDURE STEPS:
KEYPOINT:
Inoculate blood culture bottle prior to other lab tubes in multiple
sample draws. Consider any bottles that
are dropped or knocked to be damaged.
Do not use! Blood culture
bottles should be stored away from light.
1. Procedure to obtain 2 sets B.C.
KEYPOINT:
If catheter colonization is suspected, do not draw from the same site as
the first set – Ex: (Other extremity,
implantable port, Hickman). Do not
choose site above an I.V. site, but selection below I.V. site is acceptable.
2. Cleanse the skin using the blood culture chloraprep.
a. Open the kit and remove the sterile antiseptic applicator. Gently squeeze the applicator to release the antiseptic into the sponge.
b. Thoroughly scrub the site in a back and forth and up and down motion for 30 seconds. Allow to dry for 30 seconds.
KEYPOINT: Palpate site before prepping skin and visually target as site cannot be touched again.
KEYPOINT:
If drawing from central or arterial line, clean each infusion cap or
leur-lock connection with a separate blood culture Chloraprep. Allow to dry before collecting blood.
KEYPOINT: For immunosuppressed
patients, do not waste any blood prior to obtaining cultures from central
venous catheter. To discard or not to
discard is based on physician preference and the type of sepsis being assessed.
3. Vigorously wipe septa of the blood culture bottles (or Isolator tube) with 70% alcohol. Keep septa covered at all times before injecting blood with alcohol prep pad to prevent airborne containments away from septa.
KEYPOINT:
The septum of the blood culture bottle (or Isolator tube) is not sterile
and must be disinfected before injecting blood.
4. Apply gloves and collect a full 10 ml per bottle (adults) and 1 – 1.5 ml (1 ml minimum) per bottle in neonates. If blood cultures for Histoplasma are to be done, draw an additional 10 ml for a total of 30 ml for adults.
KEYPOINT:
If drawing with a winged butterfly set you must inject the blue topped
Aerobic bottle first then the purple topped Anerobic
bottle. If drawing with a syringe,
either directly or from a central line, then you must inject the purple topped Anerobic tube first then the blue topped Aerobic tube last.
5. Inject 10 ml of blood into one bottle. If using vacutainer adaptor, be careful not to over fill the bottle.
6. Inject remaining 10 ml of blood into other bottle.
7. Inject 10 ml into Isolator tube (if blood cultures for Histoplasma are ordered).
KEYPOINT:
DO NOT change needles between drawing the specimen and inserting
the specimen into collection container.
KEYPOINT:
If you are able to obtain only 8-10 ml:
inoculate ONLY the aerobic bottle and send to the lab. Note on the transmission slip or lab request
that only one bottle was sent due to volume.
8. If culture for Histoplasma is ordered, inject 10 ml of blood into fungal isolator tube.
9. Mix blood in bottles by inverting bottles 4-5 times.
10. Place patient label on each bottle.
§ Align the lab label with the bottle label covering the 5 ml incremental marks, but allowing the fluid level to be seen.
§ The Bolded label number is nearest the cap or septum end.
KEYPOINT:
Put your initials, site, and time drawn on labels.
KEYPOINT:
If blood is drawn from a CVL, flush according to unit specific
guidelines.
11. Fill out microbiology specimen transmission slip.
KEYPOINT:
Put your signature, site, and time drawn on slip. Check box for B.C. or culture for
Histoplasmosis as ordered. State probable diagnosis, type of antibiotics, if applicable, on
slip. If from
central line, record lumen drawn from.
12. Send samples immediately to lab.
13.
Second set
of blood cultures should be drawn from a separate site 5-30 minutes after the
first set or according to unit/clinic specific protocol.
REFERENCES:
Q-Probes 93 – 08, “Blood Culture Contamination: Data Analysis and Critique” Blood Cultures. “Collection, transport, and procession of blood cultures.” Clinics in the Lab. Medicine. 994: Vol. 14, pp. 59-68.
Bates, D.W.; Golman, L.; Lee, T.H. Contaminant blood cultures and resource utilization: The true consequences of false-positive results. JAMA. 1991: 265: 365-369.
Baron, E.J.; Finegold, S.M., (Editors), Bailey and Scott’s Diagnostic Microbiology, 8th Edition, pp 204-205. 1990.
Isenberg, H. (editor in chief), Clinical Microbiology Procedures Handbook, 2nd edition, pp. 3.4.1.2-3.4.1.4, 2005.
RESOURCE PERSON(S): Connie Cavenaugh, RN (Infection Control); Kim Hoffman, MT (ASCP) (Microbiology); Dana Hobby, RN, CHES, Staff Education