PC 4006: Blood Culture Procedure
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/Patient Care Policy
Title: Blood Culture Procedure
/ Policy Number:PC 4006
Origination Date:
04/96
Effective Date:
2/2009
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POLICY STATEMENT
It shall be the policy of Memorial Health University Medical Center to use aseptic technique when collecting blood cultures.
DEFINITION OF TERMS
Set - 2 bottles (blue-aerobic, purple–anaerobic/ both collected at the same time), or a single yellow pediatric/low volume bottle).
Group - multiple sets collected within 15 minutes of each other (ex. 2 of 2, 3 of 3) or drawn at same time from different sites.
COLLECTION PROCEDURE
A. Blood cultures shall be collected for evaluation of possible bacteremia or septicemia prior to the introduction of antimicrobial therapy or when clinical conditions dictate.
B. No more than three (3) sets per 24 hours shall be drawn per patient unless patient’s condition warrants more as determined by the attending physician. Multiple sets of blood cultures should be obtained by separate needle sticks from different sites, using a syringe or blood culture collection kit. A sterile needle must be used for each stick.
If drawing from a central intravenous line and multiple sets are ordered, draw one from the central intravenous line and one from the peripheral intravenous line.
C. Confirm order, identify patient, and explain procedure to patient.
D. Prepare collection site – venipuncture (refer page 2) items i and j.
1. Assemble Materials
a. Bacti Alert Aerobic Blue Top Bottle
b. Bacti Alert Anaerobic Purple Top Bottle
c. Bacti Alert Yellow Top Pediatric/ Low volume Bottle
d. Bacti Alert Acid Fast/TB Black Top Bottle (must request from the lab)
e. Sterile 10cc Syringe
f. Bufferfly needle and blood culture adapter
g. Gloves
h. Sterile Gauze Pads
i. 70% Isopropyl or Ethyl Alcohol
j. Mediflex ChloraPrep – 2% chlorhexidine gluconate and 70% isopropyl alcohol
2. Wash hands, don gloves.
3. Palpate to locate the vein.
4. Hold ChloraPrep applicator with sponge facing downward and gently squeeze wings, releasing solution for a controlled flow. Press sponge against skin and apply ChloraPrep solution using back-and- forth friction scrub at the intended puncture area. Allow area to air dry for approximately 30 seconds.
5. Disinfect the bottle stopper by swabbing with alcohol and allow it to set for 1 minute.
6. Further palpation of the vein is not recommended, but if necessary, palpate above the site where you are drawing to keep area sterile.
7. Venipuncture shall be performed according to established guidelines, closing butterfly off at vein site.
8. Adhesive or tight dressings shall be avoided.
9. Mix bottles 4 or 5 times.
E. Prepare Collection Site - Central Lines
1. Blood cultures shall not be collected through indwelling catheters unless so directed by the physician. Identify the patient, confirm the order, and explain the procedure to the patient.
2. Wash hands and assemble supplies as follows:
a. Sterile 10cc syringe
b. 21 gauge needles with guards (X2)
c. Needle-less access with cap
d. Sterile 4x4 gauze pads
e. Goggles and gloves
f. Heparin flush (Groshong catheters do not require heparin flush or clamping)
g. Alcohol swabs
h. Appropriate blood culture bottle(s)
i. 20cc NS in syringe
4. Don goggles and gloves and open supplies, maintaining aseptic technique.
5. Place a 4x4 under the access tip of the central catheter.
6. Cleanse the connections with ChloraPrep. Allow to air dry.
7. Clamp the catheter (unless it is a Groshong)
8. Discard 10 ml from line prior to collection of blood cultures.
9. Aspirate 5-10cc blood for specimen depending on bottle or specimen collection type. (Volume may differ with pediatric patient). See Section G, Collection of Specimens.
10. Clamp the catheter (if not a Groshong). Re-attach another sterile 10cc syringe. Aspirate 5-10cc for second bottle.
11. Use the 21 gauge needle with guard to inoculate the blood into the culture bottles. Change needle between bottles. See Sections F, G, H.
12. Flush the central line with 10cc NS followed by heparin flush if appropriate, maintaining positive pressure on the plunger. (Flush volume may differ with pediatric patient).
13. Apply a sterile cap to the needle-less injection site on the access tip of the central catheter.
14. NOTE: a peripheral culture should also be drawn, if ordered.
15. NOTE: when collecting a fungal blood culture, use a separate (yellow) bottle
F. Prepare Blood Culture Bottle(s)
1. Turn the bottle upside down to view the sensor. DO NOT USE bottles if sensors have turned any shade of yellow. Sensors should be dark charcoal gray.
2. The blood culture bottles must be at room temperature.
3. Remove the flip-top cap from the bottle(s) chosen (see chart below). Swab the septum with 70% alcohol and allow to dry.
4. After inoculation of TB or AFB bottles, the septum must be swabbed again with 70% alcohol.
5. DO NOT USE ChloraPrep ON TOPS OF BLOOD CULTURE BOTTLES.
G. Collection of Specimen
1. Venipuncture or central line draw are the only approved collection sites. Heel stick or finger stick are not appropriate sites.
2. Volume Guidelines
/ Test Code / Bottle Description / Ideal Volume Per Bottle / Difficult Draw Minimums /Routine Blood Culture Adult / BLDC / Blue Fliptop and Purple Flattop / 10.0 ml / 5.0 ml
Routine Blood Culture Pediatric / BLDC / Yellow Fliptop / 4.0 ml / 1.0 ml
Acid Fast/TB Blood Culture / BLAFBC / Black
Flip top * / 5.0 ml / 5.0 ml
Fungal Blood Culture / BLFUNC / Yellow or Blue
Flip top / 4.0 ml (yellow)
10.0 ml (blue) / 1.0 ml (yellow)
5.0 ml (blue)
* Call Laboratory for bottle(s) to collect Acid Fast/TB cultures.
3. If a minimum of 5 ml cannot be obtained for a routine adult blood culture, a pediatric bottle (and pediatric volumes) may be used.
4. Low volume draws may result in false negative cultures.
5. Use pediatric (yellow) bottles for patients weighing 30 kilos or less (<66lbs).
H. Inoculation of Bottles
1. Place a new needle on the syringe before inoculating the bottles.
2. Volumes injected into the bottles should be split equally if more than one bottle is being used. Remember to change needles between cultures.
3. Label the bottle with:
a. Patient’s name
b. Patient unit number
c. Room number/location
d. Date and time the specimen was drawn
e. Physician’s name
f. Collector’s initials
g. Site of the draw
4. Document collection on patient record.
I. Specimen Transport
1. Blood cultures must be transported to the laboratory as soon as possible after collection. Never exceed thirty (30) minutes.
2. Transportation may be personal delivery or via pneumatic tube system.
Procedure for Physician Practices
A. Collection: Follow steps A-G
B. Substitute step H- 3 with the following:
1. Label the culture bottle with:
a. Patient’s name,
b. Patient’s identification number if applicable,
c. Date and time the specimen was drawn,
d. Physician’s name,
e. Collector’s initials,
f. Site of the draw.
2. Document collection on the patient’s record.
C. Substitute Step 1 with the following
1. Package and send blood cultures to the designated reference lab
according to the lab’s instructions.
PC 4006: Blood Culture Procedure
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Approved by:
William E. Check, M.D.
Medical Director, Laboratory Services
Ramon V. Meguiar, M.D.
Sr. Vice President & Chief Medical Officer
______
Karen Watts, RN, MSN
Sr. Vice President & Chief Nursing Officer
Original Implementation Date: 04/01/96
Originating Department: Department of Nursing
Next Review Date: 2/2012
Past Revised Date: 09/97; 03/98, 12/99, 1/00; 11/04; 9/05; 9/08; 2/09
Past Reviewed Date: 11/96; 09/97; 02/01
Former Policy Number(s): Patient Care Policy B2; PE 1002
Cross Reference(s):
Attachment(s):