Stop the Line: Blood Culture Positive Review

Neonatal Intensive Care Unit

Patient Name: ______Acct#: ______DOB: ______EGA:____

Birth weight: ______Diagnosis: ______

Sepsis Presentation and Blood Culture Information
Culture #1 / Culture #2
Date/Time drawn Volume: _____ml / Date/Time drawn Volume: _____ml
Site: / Site:
Time to positivity _____ hours / Time to positivity _____ hours
Organism: / Organism:
Other + cultures with this wkp: / Other + cultures with this wkp:
Catheter Information
1. Lines indwelling 48 hr before & after + culture: PIV UAC (# days in ) UVC (# days in ) PICC
2. Line day # Site: Skin prep used: CHG/PI
3. Date line placed/inserter name:
4. Line tip position originally: At time of sepsis presentation:
5. Phlebitis noted at any time during life of catheter?
6. # times catheter accessed/day:
7. What is infusing via catheter:
Events within the last week:
1. Medications infused (name, #/day):
2. Blood infused (# infusions/week; via CVC?):
3. Line leaking events? Y/N Line repaired/exchanged? Y/N
4. Last dressing change: Date _____ Is BioPatch in place? Y/N
5. Site appearance day culture drawn:
6. WBC: CRP: L Shift: Y / N
7. Reason for sepsis work up:
8. Antibiotics Started (type/start date)
9. Antibiotic stop date
10. Fluconazole prophylaxis: Y/N Other antibiotics used 7 days prior to +BC: Y/N
Patient Information
1. # IV start attempts in the last week?
2. Amount of enteral feeds (ml/kg); Breast milk/formula
3. Apnea/bradycardia spells (#/day in last 7 days):
General Events
1. Need for catheter discussed every day: Y/N
2. Dressing assessed every day: Y/N
3. What is compliance with scrubbing hub 10 seconds before accessing: 3 samples prior to + BSI
4. What is compliance for clean IV tubing set-up & tubing change:
5. What is compliance with closed system: medication/IV tubing:
6. What is compliance with line entry for blood sampling:
5. Hand hygiene compliance for month prior to BSI:

Comments: