Blood Culture

CXBLD

Adults 20 mL Total 5 -10 mL In Anaerobic (Purple) Bottle, 5 - 10 mL In FAN Aerobic (Green) Bottle. Pediatrics: See special instructions. Use pediatric (Yellow) Bottle

BLOOD CULTURE COLLECTION
Select a different site for each culture drawn.  Avoid drawing through indwelling IV or intra-arterial catheters unless blood can absolutely not be drawn by venipuncture or unless a catheter related sepsis is suspected. (This procedure is to be performed by trained nursing staff it is not performed by phlebotomy staff).
 
Site preparation
            Mediflex Prep Kit (Isopropanol & tincture of Iodine)

1. Hold applicator with sponge facing downward and gently squeeze wings, releasing 70% isopropyl alcohol solution.
2. Press sponge and apply alcohol solution using a back and forth friction scrub for 30 seconds.
3. Aseptically remove the iodine Frepp and crush the ampule.
4. Starting the center of the site, swab in a concentric motion towards the outside with 1-2% tincture of iodine for 30 s. or with 10% povidone-iodine for 1 minute).
5. Allow venipuncture site to completely dry.
6. Do not touch venipuncture site after preparation and before phlebotomy.

 
            Chloraprep® One Step Frepp®

1. Hold applicator with sponge facing downward and gently squeeze wings, releasing 2% chlorohexidine gluconate (w/v) and 70% isopropyl alcohol solution (v/v).
2. Press sponge and apply Chloraprep solution using a back and forth friction scrub for 30 seconds.
3. Allow area to dry for approximately 30 seconds.                 

 
Disinfecting blood culture bottles

1. Remove flip cap from bottle.
2. Disinfect top of bottle with alcohol and allow to dry.
3. Set bottles in an upright position at the patient’s bedside.

 
Collection of blood for culture

1. Connect the adapter cap to the leur connector of the appropriate size safety butterfly needle. Insert needle into vein, and hold securely (with tape if necessary). Place the adapter on the FAN aerobic culture bottle septum (or other bottle) and press down to penetrate and obtain blood flow. Observe the demarcations on the side of the bottle and use as a guide to withdraw 10 ml of blood/bottle. Do not use a direct draw device-you must watch level.
2.  After obtaining the appropriate amount of blood (5-10 ml/bottle –adults, up to 4 ml pediatrics), move the adapter cap from the aerobic to the anaerobic bottle and continue collection. Do not remove needle from patient’s arm during this process.
3. Mix well to avoid clotting
4. If vein is missed on first try, get a new needle.  If additional blood is required for other tests, place the adapter insert into the adapter cap and lock it in place by rotating 90° in either direction. Insert required vacuum collection tubes.

 
After phlebotomy is complete, remove the adapter cap from the culture bottle and then remove the needle from the patient’s arm. Cleanse the venipuncture site with 70% alcohol to remove remaining iodine, which can cause irritation in some patients.  Label both bottles with the patient’s name, date and time of draw, and phlebotomist’s initials. Send to Microbiology as soon as possible (within 1 hour of draw).
 
Central line cultures and other intravascular devices
Drawing blood cultures through indwelling catheters should be avoided unless the specimen cannot be obtained through a peripheral stick. Samples drawn through a catheter suspected of causing a catheter related infection should be accompanied by peripheral cultures as well. This procedure is to be performed by trained nursing staff it is not performed by phlebotomy personnel.
 
Prepare clean work area and gather the following supplies:
Alcohol wipes
10% povidone iodine solution
5-10 cc discard syringe
10-20 cc sampling syringe
20 cc normal saline
Gloves
 
Collection

1. Wash hands thoroughly and apply gloves.
2. Stop fluids by turning off pump.
3. Disinfect catheter entry site with alcohol wipe followed by povidone iodine.  Povidone iodine must be left on for 1 minute in order to be effective.
4. Clean top of blood culture bottle with both alcohol and povidone iodine in a similar manner.
5. Flush port with 20 cc of Normal saline.
6. Withdraw 5-10 cc of blood in discard syringe. Discard. If using an open system, clamp catheter between syringe changes.
7. Withdraw 10-20 cc sample of blood and inoculate blood culture bottles with 5-10 ml.
8. Restart fluids.
9. Label bottles with patient information, date and time of draw, initials of individual drawing the blood. Indicate that the specimen is a line draw.

  


Pediatrics: Place 0.5 - 4.0 mL In aerobic (Yellow) PedibacT Bottle. Blood Cultures should be drawn prior to initiation of antimicrobial therapy. More than one culture recommended per septic episode. Each culture represents one venipuncture. Virtually all significant bacteremias will be detected by three blood cultures drawn using strict aseptic technique. Blood cultures may be drawn from catheter lines if clearly labeled as such and accompanied by peripheral cultures (Phlebotomy Staff will not collect these specimens.) However, results should be interpreted with caution due to the likelihood of contamination. Refer to special collection procedures. Each culture consists of 2 bottles, each containing 10 mL. of blood. FAN Aerobic (Green) must be drawn on patients receiving antibacterial therapy. If anaerobic bacteria are not suspected, two FAN bottles may be drawn. Negative results available in 5 days. Positive bottles will be gram stained, and significant organisms identified to the species level. Testing will be performed on clinically significant isolates for which interpretive criteria exist. Susceptibilities will not be performed on the following organisms: Bacillus Spp., Corynebacteria Spp., Proprionibacteria Spp., Anaerobic Organisms, Viridans Strep, and Coagulase Negative Staph in a single bottle.