Venipuncture Collection:
Prepare the venipuncture site. Identify the vein by palpitation. For patients > two months of age, use a 1ML Swabstick, Chlorhexidine Gluconate/70% IsoproAlcohol with a scrubbing action, passing multiple times over the site for 30 seconds. Friction is an important part of the cleansing process for this product. For patients < two months of age, use 3 rounds of 70% alcohol pads and scrub the site in an up and down friction motion. Allow to dry for 30-60 seconds regardless of the type of prep used.
Venous Access Device Collection: (Refer to your institutional "Indwelling Line" policy)
Obtaining blood for culture from intravascular lines, especially if it is used to administer antimicrobial agents, is discouraged. If it is necessary to collect by IV line, the line must be flushed with an appropriate parenteral fluid by the nursing staff prior to obtaining blood for culture. Collect at least one culture by venipuncture if possible rather than two by catheter.
Draw 20 mL (per culture) of blood using a 20 mL syringe (or smaller if needed) with a butterfly or syringe needle. Label bottles with patient identification without covering the bottles barcode. Disinfect the rubber septa of each bottle with a separate alcohol wipe. Allow the septa to air dry, and then inject blood into tube. Do not allow the septa to become contaminated.
When using BacT/Alert Fan®Plus bottles, hold bottles upright while filling to observe the 10 mL fill line. Do not overfill bottles. Over-filling could cause inaccurate results. Also, any volume below 10 mL will significantly decrease the chances of recovering an organism. The volume of blood obtained for each blood culture set is the most significant variable in recovering microorganisms from patients with bloodstream infections.
Blood drawn by syringe method
• For adults greater than 40 kg, collect 20 mL of blood, place 10 mL of blood in each bottle, inoculating the orange (ANAEROBIC) bottle first.
• If the blood volume is less than 20 mL but greater than 10 mL, divide the volume in such a way that the green (AEROBIC) bottle gets 10 mL and put the remaining volume in the orange (ANAEROBIC) bottle.
• If the blood volume is less than 10 mL, place ALL the blood in the green (AEROBIC) bottle.
Blood drawn by butterfly method
• For adults greater than 40 kg, fill the green (AEROBIC) bottle to 10 mL mark first then fill the orange (ANAEROBIC) bottle to the 10 mL mark.
Collect 2-3 bottle sets (two bottles per set) per episode for maximal sensitivity. Cultures may be drawn at the same time, but should be collected from two different sites before the administration of antibiotics if possible. Ideally, blood should be obtained during the chill or temperature spike. Otherwise, collect blood cultures as close to the precipitating event as possible. Blood is optimally obtained by venipuncture at separate sites.
Note: Yellow top Vacutainer tube containing ACD is unacceptable for blood culture.
If BacT/Alert is not available, blood may be submitted in other commercial blood culture media collected per institutional procedures. These cultures will have an analytical time of 7 days.
For all blood cultures that are predetermined to be positive, order as IDEN, Blood.