Collection And Inoculation Of Blood Specimens For Routine Culture (Bacterial, T.B. or Fungus)

Policy

When drawing multiple blood samples from a line, always draw the blood culture first. Do not discard any blood from the line. Use this initial blood in the line, as this may be the best source if an organism is present.

Equipment

Lab requisitions
Name labels
Safety Lok Blood Collection Set/Saf-T E-Z Set
Angel Wing
Blood Culture Bottles*
Skin prep kit (ChloraPrep One-Step Frepp)
Tourniquet
Gauze and paper tape
Unsterile examination gloves

Recommended Testing

1. Adults: suspected bacteremia . draw two sets of two bottles (aerobic and anaerobic) of blood cultures from two separate venipuncture sites. Maximum of 4 cultures. The aerobic bottle should be inoculated first. This is done as there is about 0.5 cc of air in the line of the collection set and sometimes it is difficult to obtain 8 . 10 cc blood per bottle (15-20 cc/set). The aerobic bottle is the more critical one to inoculate short samples into. The small lines on the edge of the label indicate approximately 5 cc. It is important not to overfill the bottles as this could adversely affect the results.

2. Pediatrics/Neonatal Patient: one aerobic (green topped) bottle as ordered by the physician. Recommended volume: 1 to 2 cc. of blood per bottle.

3. Blood Culture for TB: two heparin (green topped) or two SPS (yellow topped) vacutainers. No more than once per 24 hour period.

4. Quantitative Blood Cultures to R/O Line Infection: see separate .Quantitative Blood Culture. procedure in Department of Nursing .Policy/Procedure/Standards Manual.

5. Blood Culture for Fungus: One aerobic (green topped) blood culture bottle.

Method/Procedure

1. Confirm identity of patient making sure that the requisition and labels match the name bracelet.

2. Explain the procedure to patient.

3. Select site for the venipuncture.

4. Remove caps from bottle(s) and wipe bottle top(s) with 70% alcohol prep pad.

5. Skin Preparation and Specimen Collection/Inoculation:

a. ChloraPrep One-Step Frepp

1. Locate the vein to be used.

2. Remove Frepp from package. Hold the applicator with ChloraPrep One-Step Frepp sponge facing downwards and gently squeeze wings, releasing solution for a controlled flow.

3. Place sponge on selected venipuncture site and depress once or twice to saturate sponge.

4. Use a back and forth friction scrub for at least 30 seconds.

5. Allow area prepared to dry for approximately 30 seconds.

6 Proceed with collection of blood.

b. Do not wipe off . if you do, you have then contaminated the site.

6. Maintain a "hands-off" approach during the prep procedure. If it is necessary to touch the cleansed site, prep the glove finger in the same manner with a fresh prep pad and only palpate above and below needle insertion site.

7. Using the butterfly Safety E-Z Collection Set and a "male" Angel Wing perform the venipuncture. Blood should .flash. back into the tubing.

8. Insert blood culture bottles onto adapter. Collect 10 cc. of blood into each bottle. Note: Collect blood in the aerobic bottle first as there is about 0.5 cc of air in the line of the butterfly and in case less than 10 cc is obtained.

Line Draw

9. When drawing from a line there are two methods:

a. Directly insert .male. angel wing to the clave connector OR

b. Apply syringe to the clave, draw back specimen and then remove syringe and apply "female" angel wing to the syringe and put blood into appropriate bottles.