A B C D E F G H I J K L M N O P Q R S T U V W X Y Z #

Culture, Blood

Message
 Before administering systemic antimicrobials, the collection of 2 separate sets of blood cultures is recommended when there is a fever combined with significant leukocytosis or leukopenia.


Test Code
XBLC


Alias/See Also
 Blood culture, BACTEC,  Routine Blood Culture



Preferred Specimen
Adult:  8-10mL Whole blood (minimum 8 mL)
Pediatric: 1-3mL Whole blood (minimum 0.5mL)


Instructions
Prior to use inspect all bottles and discard any vials showing evidence of contamination, damage, or deterioration (chipped bottle, turbid media, etc).
Verify expiration date on all bottles and discard any that have been exceeded.
Inquire if patient has a history of adverse reaction to Chlorhexidine gluconate (CHG) or tincture of iodine. If so, see special instructions for using alcohol scrub.
Blood for culture should NOT be drawn through indwelling intravenous or intra-arterial catheter unless it cannot be obtained by venipuncture or unless it is being drawn to specifically evaluate a potential catheter–related infection, in which case blood should be simultaneously drawn by venipuncture from another site.
 
1. Skin preparation:
  • locate the vein to be used by palpitation
  • clean the venipuncture site with alcohol and let dry 30 seconds
a. Skin preparation - ChloraPrep Sepp
  • use aseptic technique to remove Sepp from its package
  • holding applicator sponge downward, squeeze to release solution
  • use a back and forth motion to scrub the site with the friction pad for a full 30 seconds, allow to air dry
  • ChloraPrep is a clear solution that allows you to easily see patient's vein
  • do NOT TOUCH OR PALPATE THE AREA after cleansing
Note:  Do NOT use ChloraPrep Sepp on premature infants, infants less than 2 months old or if patient is allergic. Use 70% Isopropyl Alcohol scrubs, scrub 2 times and allow to air dry.
b. Skin preparation – Tincture of Iodine (alternative method)
  • If patient has a history of adverse reaction to iodine, substitute a second alcohol swab and scrub in place of iodine.
  • Hold tincture of iodine ampule in downward position and pinch center to crush.
  • Apply tincture of iodine to venipuncture site starting at center and moving outward in concentric circles to periphery for 30 seconds. Let dry.
  • While allowing to dry proceed to the next step. DO NOT TOUCH OR PALPATE THE AREA AFTER CLEANSING.
4. Remove flip-off caps from culture vials and wipe tops of bottles with a single alcohol swab and allow to dry 1 minute.
5. Prepare blood collection set:
  • Peel apart package and remove blood collection set
  • Thread the Luer end of tubing set into vacutainer holder.
  • Remove sheath covering needle at wings
6. Collect Blood Sample:
  • Perform venipuncture by holding wings as. DO NOT hold by grasping the yellow safety shield.
  • Select aerobic bottle first. Hold the bottle upright.
  • Push and hold vacutainer holder over the top of vial to puncture septum.
  • Collect blood to desired fill level on vial. Monitor to ensure proper blood flow and fill level.
  • Remove holder from bottle. Immediately push and hold holder onto second bottle and collect blood to desired fill level on second bottle.
  • Remove holder from bottle.
7. Remove needle from venipuncture site:
  • When final vial is filled, withdraw the needle from the puncture site by grasping the wings and gently pulling. DO NOT withdraw by holding yellow safety shield.
  • Cover the puncture site with sterile gauze pad and apply mild pressure
  • To activate safety shield, grasp either wing with one hand and grip the yellow safety shield base with other hand. Slide the wings back into the rear of the safety shield until a snap is felt to ensure that the needle is retracted and completely locked in place.
8. Patient skin care:
  • After all specimens have been collected, remove tincture of iodine from around the collection site using sterile alcohol swab.
  • Apply gauze and tape or Band-Aid on venipuncture site after bleeding has stopped.
9. Label bottles:
  • Label bottles with appropriate patient label. DO NOT write or place labels over the vial barcode, as this is used by the instrument to process the specimen.
  • Indicate date and time of collection as well as collector’s initials on each bottle. Document site of draw as right vein, etc.
10. Disposal:
  • Dispose of the safety-lock blood collection set into the nearest sharps container. DO NOT disassemble the blood collection set.
  • Dispose of all other used materials in appropriate container and wash hands.
11. Transporting Specimens to the Lab:
  • Place each set in separate biohazard bag and send via pneumatic tube system using designated blood culture carrier.
  • Bottles may also be hand carried to the lab.


Transport Container
 Adult:  BACTEC PLUS Aerobic/F and BACTEC PLUS Anaerobic/F bottles  
Pediatric: BACTEC PEDS PLUS/F bottles 
Fungus or Mycobacteria (AFB): BACTEC Myco F/Lytic bottle

 




Specimen Stability
Room temperature:  48 hours, Refrigerated: unacceptable, Frozen: unacceptable


Reject Criteria (Eg, hemolysis? Lipemia? Thaw/Other?)
Blood cultures submitted in expired or refrigerated BACTEC bottles.
Blood cultures submitted in any other tube, container, etc.



Limitations

Antimicrobial therapy initiated prior to the collection of specimens may result in a false negative culture.
Media specific for the recovery of fungus and mycobacteria are recommended.




Reference Range
No growth


Clinical Significance
 The detection of microorganisms in a patient’s blood has diagnostic and prognostic importance.   Bacteria multiply at a rate that exceeds the capacity of the reticuloendothelial system to remove microorganisms, bacteremia results.  Bacteria usually enter the blood from extravascular sites via lymphatic vessels.  Direct entry of bacteria into the bloodstream occurs as well with intravascular infections, such as infective endocarditis, infected arterio-venous fistulas, mycotic aneurysms, suppurative phlebitis, infected IV catheters, and infected indwelling arterial catheters.  The clinical pattern of bacteremia can be transient, intermittent, or continuous, and bacterial sepsis constitutes one of the most serious infectious diseases.  The expeditious detection and identification of blood-borne bacterial pathogens is one of the most important functions of the diagnostic microbiology laboratory.




The CPT Codes provided in this document are based on AMA guidelines and are for informational purposes only. CPT coding is the sole responsibility of the billing party. Please direct any questions regarding coding to the payor being billed. Any Profile/panel component may be ordered separately. Reflex tests are performed at an additional charge.