Blood Culture

CSB

If positive, a gram stain, identification, and sensitivity will be performed at an additional charge. Sensitivities will only be performed on true positives (specimens that show no evidence of contamination with skin flora). Sensitivities will only be performed on one set of bottles if more than one set is positive.

16-20mL blood for adults, 1-3mL blood for children. Two to three blood specimens collected within 24 hours from separate venipunctures, before initiation of antibiotics is recommended. Please specify body site for all specimens.

A. Equipment

1. 3% CHG swab
2. 10 cc syringe
3. 2x2 sterile gauze
4. Tourniquet (rubber band or gently constriction with the hand)
5. Blood culture bottle (Anaerobic and Aerobic)
6. For neonatal, please use Lippincott Neonatal Blood Culture Sample reference
7. Needle size - either 23g or 25g as appropriate to patient (angiocath or butterfly)

B. Procedural Notes

1. At least two sets of blood cultures should be done (15 minutes or more aparat and at two different sites).  If blood cultures ordered they should be obtained prior to starting antibiotics.
2. If unable to draw blood cultures until after starting antibiotics please notify Provider.
3. Do not use a cleansing product that contains alcohol if patient is having a blood alcohol level drawn.
4. Do not use Pedi blood culture bottles on adult patients.  The broth forumlation and volume of broth is different in adult vs. Pedi bottles which can affect the results of the culture.  If you need to use Pedi bottles on adult patients, the lab and the provider need to be notified.
5. Remove plastic cap from each blood culture bottle and disinfecting top of bottle or tube with 70% isopropyl alcohol pad and allow top to dry.
6. Do not use iodine to disinfect top of vials
7. Select a site either peripheral or central line and follow correct procedure.  Select a different site for each culture drawn.
8. It is best that blood cultures are not obtained through intravascular lines as these lines often become colonized and result in false-positive blood cultures.  If you need to draw from the central line draw second set peripherally.
9. Volume of blood collected in the bottles is significant factor in ensuring isolation of bacteria.  Adults 10 ml per bottle and 4 ml per Pedi bottle.  Mark the desired fill level on the bottles.
10. When other lab work is needed, blood cultures should be done first.
11. Draw off new peripheral IV only.  If IV is not new do not draw off it.

C. Procedure for peripheral Draws (RN's, Lab Techs, CT's, Lab Assistants)

1. Wash hands and put on gloves
2. Confirm patient's identity with Name and Date of Birth
3. Palpate the vein selected.  NOTE: Many usable veins cannot be seen but can be palpated.
4. Cleanse skin with soap and water if visibly dirty.  Then vigorously cleanse the venipuncture site with alcohol swab.  Allow to dry.
5. Starting at the center of the site,

• a) Swab (3% chlorhexidine glucontate and isopropyl alcohol 70%) back and forth for 30 seconds.  For Infants less than 2 months old, use iodine or betadine instead of chlorhexidine.
• b) Allow area to air dry completely.  Do not blot or wipe dry.  Avoid contaminating site after prep is done.  Do not re-palpate the venipuncture site after preparation and prior to phlebotomy.

6. Open sterile needle and holder or blood collection set from package and assemble.
7. Thread needle into holder
8. Insert culture bottle into holder (draw aerobic then anaerobic bottle) until end of needle meets top of stopper.  Leave in this position.
9. Apply tourniquet.
10. Lower the patient's arm until it is in a vertical position.  The bottle, with its stopper uppermost, must be held vertically below the venipuncture site prior to penetration.  The medium should not be in contact with the stopper during venipuncture.
11. Remove needle shield and perform venipuncture.  Hold the needle at a 30 degree angle or less; pierce the skin slightly to one side over the vein.  Enter the vein with gentle pressure, bevel up.
12. If needle is in vein, blood will flow into bottle.  If blood does not flow, remove needle and bottle at once and repeat procedure with new venipuncture equipment and culture bottle.
13. Remove tourniquet as soon as blood starts to flow.

E. For Both Peripheral and Central Line Blood Draws:

1. Volume of blood collected in the bottles is significant factor in ensuring isolation of bacteria.  Adults 10 ml per bottle and 4ml per Pedi bottle.  Mark the desired fill level on the bottles.
2. Immediatly after blood ceases to flow into bottle, remove bottle from holder.  It is normal for the bottle not to be completely filled (sufficient volume to attain a 1:10 ratio of blood to medium).  In infants and children the concentration of organisms during bacteremia is higher than in adults, so less blood is required for culture (1-4ml).  Document amount removed from infants in patient chart.
3. Mix blood and culture medium by inverting bottle four or five times.
4. Place patient label on bottle in position that does not cover bar code.
5. Document site of blood draw on the label.  Include your ID number, date and time of draw.
6. Remove gloves and wash hands.
7. Bottles should be immediately transported to the laboratory.

Bactec Plus Aerobic Bottle -and- Bactec Plus Anaerobic Bottle Alternative: Bactec Peds Plus/F Bottle (for pediatric patients)

Room Temperature

Room temperature: 24 hours
Refrigerated: Not recommended
Frozen: Unacceptable

Daily

Negative Culture - Finalized at 5 days

Critical Values
Positive Gram Stain
Positive Culture (1st collection)

The detection of microorganisms in a patient's blood has diagnostic and prognostic importance. Blood cultures are essential in the diagnosis and treatment of the etiologic agents of sepsis. Bacterial sepsis constitutes one of the most serious infectious diseases.