Obtaining a Venous Blood Specimen for Culture and Sensitivity
Goal: An uncontaminated specimen will be obtained without the patient experiencing undue anxiety and injury.
1. Gather the necessary supplies. Check product expiration dates. Identify ordered tests and select the appropriate blood-collection tubes. If tests are ordered in addition to the blood cultures, collect the blood-culture specimens before other specimens.
2. Identify the patient. Explain the procedure. Allow the patient time to ask questions and verbalize concerns about the venipuncture procedure.
3. Close curtains around bed and close door to room if possible.
4. Provide for good light. Artificial light is recommended. Place a trash receptacle within easy reach.
5. Assist the patient to a comfortable position, either sitting or lying. If the patient is lying in bed, raise the bed to a comfortable working height. Expose the arm, supporting it in an extended position on a firm surface, such as a table top.
6. Perform hand hygiene.
7. Determine the patient’s preferred site for the procedure based on his or her previous experience. Apply a tourniquet to the upper arm on the chosen side approximately 3” to 4” above the potential puncture site. Apply enough pressure to impede venous circulation but not arterial blood flow.
8. Assess the veins to determine the best puncture site. Observe the skin for the vein’s blue color, or palpate the vein for a firm rebound sensation.
9. Release the tourniquet. Check that the vein has decompressed.
10. Attach the butterfly-needle extension tubing to the Vacutainer device.
11. Move collection bottles to a location close to arm, with bottles sitting upright on table top.
12. Put on nonsterile gloves. Clean the patient’s skin at the selected puncture site with the antimicrobial swab. If using chlorhexidine, use a back-and-forth motion, applying friction for 30 seconds to site, or procedure recommended by the manufacturer. Allow the site to dry.
13. Using a new antimicrobial swab, clean the stoppers of the culture bottles with the appropriate antimicrobial, per facility policy. Cover bottle top with sterile gauze square, based on facility policy.
14. Reapply the tourniquet approximately 3” to 4” above the identified puncture site. Apply enough pressure to impede venous circulation but not arterial blood flow.
15. Hold the patient’s arm in a downward position with your nondominant hand. Align the butterfly needle with the chosen vein, holding the needle in your dominant hand. Use the thumb or first finger of nondominant hand to apply pressure and traction to the skin just below the identified puncture site. Do not touch the insertion site.
16. Inform the patient that he or she is going to feel a pinch. With the bevel of the needle up, insert the needle into the vein at a 15-degree angle to the skin. You should see a flash of blood in the extension tubing close to the needle when the vein is entered.
17. Grasp the butterfly securely to stabilize it in the vein with your nondominant hand, and push Vacutainer onto the first collection bottle (aerobic bottle), until the rubber stopper on the collection bottle is punctured. You will feel the bottle push into place on the puncture device. Blood will flow into the bottle automatically.
18. Remove the tourniquet as soon as blood flows adequately into the bottle.
19. Continue to hold butterfly needle in place in the vein. Once first bottle is filled, remove the Vacutainer and place on second bottle. After the blood culture specimens are obtained, continue to fill any additional required tubes, removing one and inserting another. Gently rotate each bottle and tube as you remove it.
20. After you have drawn all required blood samples, remove last collection tube from the Vacutainer. Place a gauze pad over the puncture site and slowly and gently remove the needle from the vein. Engage needle guard. Do not apply pressure to site until the needle has been fully removed.
21. Apply gentle pressure to the puncture site with the gauze pad for 2 to 3 minutes or until bleeding stops.
22. After bleeding stops, apply an adhesive bandage.
23. Check specimen labels with patient identification bracelet. Label should include patient’s name and identification number, time specimen was collected, route of collection, identification for person obtaining sample, and any other information required by agency policy Place label on the culture bottles per facility policy. Place culture bottles and any other collection tubes in plastic sealable biohazard bags, according to facility policy. Immediately transport to laboratory.
24. Check the venipuncture site to see if a hematoma has developed.
25. Discard Vacutainer and butterfly needle in sharps container. Remove gloves and perform hand hygiene.
26. If a second set of blood cultures is ordered, repeat the procedure, collecting from another site or wait the specified time to obtain the specimen.
27. Assist the patient to a comfortable position. If patient’s bed was raised, place the bed in the lowest position.