SARASOTA MEMORIAL HOSPITAL TITLE: NURSING PROCEDURE BLOOD CULTURE COLLECTION PROCEDURE (spe20) DATE: REVIEWED: PAGES: 6/10 2/19 1 of 6 PS1094 ISSUED FOR: Nursing/Lab RESPONSIBILITY: RN, LPN II, select MST, Phlebotomists PURPOSE: DEFINITIONS: To obtain blood cultures using aseptic technique to prevent contamination of the specimen. The staff member will follow standard precautions when performing this procedure. Each blood culture order consists of two bottles defined as: one aerobic bottle (REDOX 1 Purple border) injected with 5-10 ml of blood and one anaerobic bottle (REDOX 2 red border) injected with 5-10 ml of blood. Patient Identification Labels labels include bedside ID label system (Lab Information System LIS) bar-coded labels), Easy ID bar coded patient labels, and Lab system labels. LIS bar-coded labels are preferred and REQUIRED WHEN AVAILABLE. Final Check process for verification of correct specimen labeling. Final check is performed at bedside by staff that collected the specimen immediately upon obtaining specimens. Final check verification is done for each specimen collected by reading out loud the last 3 digits of the patients visit number and then reading out loud the last 3 digits of the patient visit number on the patient identification band. EXCEPTIONS: NICU: refer to Venipuncture Blood Collection for Neonatal Labs and Blood Cultures in the NICU (nur48) Pediatrics: For pediatric patients, use single aerobic bottle (REDOX 1 Purple border). Use ChloraPrep One-Step or equivalent. Pediatric patients under 12 years old-amount drawn depends on the age of a child and minimum is 0.1 ml. Place in aerobic bottle only. Pediatric patients 12 years old and older-recommended fill is 5-10ml (do not fill over 10ml). Place in aerobic bottle only. EQUIPMENT: Equipment for Peripheral Venipuncture:
BLOOD CULTURE COLLECTION PROCEDURE (spe20) PAGE: 2 of 6 1. ChloraPrep One-Step Swabstick or equivalent (Chlorhexidine Gluconate 2% and Isopropyl Alcohol 70%). 2. 70% alcohol swab 3. Blood culture bottles aerobic(redox 1 Purple border) and anaerobic(redox 2 red border) 4. Gauze 5. Tourniquet 6. Butterfly with short adapter or syringe 7. Syringe 21 g, 12 Tubing with Saf-T Holder Devise with Female Luer Adapter (Butterfly) 8. Syringe needle and Saf-T Holder Device with Multi Sample Male Luer Adapter* *The choice of needle will depend on the type of vein the patient possesses. The most commonly used needle is a 21 gauge. For patients with small or fragile veins a 23 or 25 gauge needle is recommended. The length of the needle may be 1 or 1- ½, but a 1 length needle is usually adequate. 9. 23 gauge blood collection set (butterfly) for pediatric patients 10. Adhesive bandage 11. Non-Sterile gloves 12. Curos caps 13. Patient Identification Labels Note: Do not use blood collection supplies that are expired. Do not use if any defect is noted in the bottles such as cracks, contamination, excessive cloudiness, and bulging or indented stoppers. PROCEDURE: Procedure for Peripheral Venipuncture: 1. Correct patient identification must be verified in accordance with Policy 01.PAT.09, Patient Identification Inpatient/Outpatient. Hand hygiene per policy (01.IFC.67) Hand Hygiene. 2. Prior to collecting specimens in areas where armbands are required, each specimen label must be verified against the patient's armband using 2 identifiers. In areas where armbands are not required, each specimen label will be checked against patient's verbal verification. 3. Perform hand hygiene and identify patient per SMH policies 4. Perform hand hygiene and prepare all supplies needed on a cleaned surface. 5. Prep the blood culture bottles by marking or check 10ml line on bottles before drawing. Bottles will not automatically fill to appropriate volume. They can over fill causing false positive readings. Rub with an alcohol prep to disinfect the septum (top). Never use iodine. Allow to air dry. 6. Don gloves. 7. Apply tourniquet to the patient and select an appropriate venipuncture site. 8. Prep the area of approximately 2.5 x 2.5 inches using repeated firm back and forth strokes for a minimum of 30 seconds.
BLOOD CULTURE COLLECTION PROCEDURE (spe20) PAGE: 3 of 6 Allow the area to AIR dry. Do not blow or fan. Obtain the blood sample without touching cleaned site prior to drawing or the site must be cleaned again. 9. Using the adapter, insert the needle through the septum (top) of the aerobic bottles first (silver top and purple border) and then the anaerobic bottle (red top and red border). Proceed with other blood specimens following the blood cultures. 10. If using a syringe needle instead of a butterfly to collect the specimen, activate the safety device on the collection needle and discard. Attach proper transfer adapter to syringe and inoculate the bottles. 11. If additional blood is required for other tests, insert tubes directly into adapter. 12. Remove needle from puncture site, activating safety device (push button butterfly needles remove the needle upon activation), and apply pressure to prevent bleeding. Discard sharps into a sharps container. 13. Cleanse area before bandaging if blood is visible. 14. Remove gloves and perform hand hygiene. 15. Label the bottle with the appropriate patient identification label at bedside. Do not place label on top of the barcode label or the lot numbers. Orient patient label vertically for scanning efficiency. 16. Write the Date/Time, Collector Initials on the patient identification label. (This step is not needed if you are using Lab Information System (LIS) label. Date, time and initials are already on the LIS label). 17. Perform Final Check verification for EACH specimen collected by reading out loud the last 3 digits of the patients visit number on the specimen label and then reading out loud the last 3 digits of the patient visit number on the patient ID band 18. Place bottles in plastic zip lock bag and fully seal. If the blood culture bottles are to be sent via the tube system, individual biohazard bubble bags must also be used or pink plastic carriers should be used for safer transport. 19. Clean cart surface thoroughly. 20. Adult patients: ONLY one set of cultures can be obtained with IV start following the above procedure. The blood culture must be drawn first before any other labs. Pediatric Patients: Blood specimen may be obtained with IV start, following the above procedure. AFB Blood Culture Collection 1. 5 mls of blood is collected by the methods described above and inoculated into BD BACTEC MYco/F Lytic Culture Vial bottle (white cap) or equivalent. Contact micro department for the bottle prior to collection. 2. Specimen is delivered to the lab for processing. 3. Specimen is sent off for testing, turnaround time is 6 weeks.
BLOOD CULTURE COLLECTION PROCEDURE (spe20) PAGE: 4 of 6 Fungus or Yeast Blood Culture Collection 1. Regular 5-10 ml blood culture collection into the Aerobic (purple) bottle. 2. Specimen is delivered to the lab and incubated for 4 weeks. EQUIPMENT: PROCEDURE: Equipment for Central Line Draws: 1. 70% alcohol Swab 2. Blood culture bottles aerobic (silver top with purple border) and anaerobic (red top with red border) 3. New connector 4. Flush syringes 5. Non-sterile gloves 6. Syringes 7. Needle-less transfer device 8. Patient Identification Labels 9. Curos caps Nursing Staff Only Central Line Draws (if ordered by the MD) *Correct patient identification must be verified in accordance with Policy 01.PAT.09, Patient Identification Inpatient/Outpatient. *Prior to collecting specimens in areas where armbands are required, each specimen label must be verified against the patient's armband using 2 identifiers. In areas where armbands are not required, each specimen label will be checked against patient's verbal verification. 1. Perform hand hygiene and identify patient per SMH policies 2. Perform hand hygiene. Don gloves. 3. Remove existing needleless connector. 4. Clean the hub of the central line catheter by scrubbing with alcohol wipe for 15 seconds 5. Attach new primed needleless connector and draw the waste. 6. Scrub the needleless connector with alcohol for 15 seconds. Allow to air dry. 7. Collect one set of blood cultures only. Scrub the needleless connector with alcohol for 15 seconds and allow to air dry. 8. Flush the needleless connector and catheter until clear of blood residual. Apply Curos cap. 9. Using transfer device, insert the needle through the septum (top) of the aerobic bottles first (silver top with purple border) and then the anaerobic bottle (red top with red border) injecting 5-10 ml. of blood into each. 10. Remove gloves and perform hand hygiene. 11. Label the bottle with the appropriate patient identification label at bedside. Do not place label on top of the barcode label or the lot numbers. Orient patient label vertically for scanning efficiency. 12. Write the Date/Time, Collector Initials, and site on the
BLOOD CULTURE COLLECTION PROCEDURE (spe20) PAGE: 5 of 6 patient identification label. (This step is not needed if you are using LIS label. Date, time and initials are already on the LIS label). 13. Indicate on the blood culture bottle that the sample was withdrawn from the central line by writing line draw. 16. Perform Final Check verification for EACH specimen collected by reading out loud the last 3 digits of the patients visit number on the specimen label and then reading out loud the last 3 digits of the patient visit number on the patient ID band Procedure Notes: 1. Two sets of blood cultures should not be drawn from the same site as chances of contamination are greatly increased. 2. Always inspect the bottles before use. Broth should be clear. 3. Vacuum draw for the VersaTREK bottles is more than the optimal blood volume; be sure to mark your bottles for accurate volume before drawing. Overfilling can lead to false positive results. 4. Only 3 sets of blood cultures should be drawn within a 24- hour period. 5. One must get at least 5 ml of blood on an adult patient for a blood culture. If 5 ml of blood cannot be obtained, then draw as close to 5 ml as possible so that the blood/ broth ratio is maintained. Inoculate into an aerobic bottle only. (In extreme cases the blood draw can be as little at 0.1ml, usually infants). REFERENCES: Procedures for the Collection of Diagnostic Blood Specimens by Venipuncture; Approved Standard, 6 th Edition, Clinical and laboratory Standards Institute, 2007. VersaTREK TM Automated Culture System, User Manual Version 2.1 Revision A October 2013. ChlorPrep manufacturer directions for use, CarFusion 12/23/2010. BD Persist Skin Prep Package Insert, 2011 BD Infusion Nurses Society. (2016) 4 th ed. Policies and procedures for infusion nursing.
BLOOD CULTURE COLLECTION PROCEDURE (spe20) PAGE: 6 of 6 SMH Policy. (01.PAT.09). Patient Identification: Inpatient/Outpatient. SMH: Author. Albany Medical Center. www.amc.edu/pathology_labservices/specimencollection_docs/blood_cultures1.pdf Doern, G. MD, UpToDate. Blood Cultures for the detection of bacteremia. Literature review: Dec. 2018. www.uptodate.com Dr. Richard Cooke, Consultant Medical Microbiologist, University Hospital Aintree. One Set or Two? A Review of Blood Culture Collection. Weinstein MP et. Al. Current blood culture methods and systems. Clinical concepts, technology and interpretation of results. Clin Infect Dis 1996; 23:40. AUTHORS: Marissa Starkey, MSN, RN, NPD Specialist, ECC Annette Freidhof, MSN, RN, NPD Specialist, ECC Aaron McCoy, BSN, RN, TCRN, NPD, ECC Dana Rickard, Laboratory Operations Manager APPROVAL: Clinical Practice Council 2/7/19