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STANDARDS:
* Management and care of CVC at LBH may only be undertaken by a registered nurse.*
* Procedure should be carried out under strict aseptic technique.
* To have a uniformed approach to drawing blood cultures by trained staff.
* Two sets of blood cultures consisting of two bottles per set, ie. green (aerobic) and red (anaerobes).
* Samples should be taken at least one hour apart, preferably from different sites.
* Samples ideally should be drawn before starting antibiotic treatment.
* Samples should be drawn from the patient's limbs whenever possible. Central lines and arterial lines are used only when patient's limbs are unaccessible.
* If antibiotic administration has been started collect at three separate sites on one occasion.
* Blood culture should be performed in every case of serious sepsis regardless of whether a primary site has been identified and sampled microbiologically.
OUTCOMES:
* Potential injury to the nurse will be minimised through proper use of equipment.
* No contamination of blood samples during procedure will ensure accurate results from blood sampling.
EQUIPMENT:
- Sterile dressing pack
- Rubbish bin
- Povidone-iodine
- Blood bottles x 2; red and green topped
- Eye protection
- 20 ml syringe/ 19G needle
- Large clear vacutainer shield to accommodate blood culture bottle culture
PROCEDURE:
* Explain procedure to patient before starting.
* Set up dressing tray with Povidone-iodine on over-bed table at patient's bedside.
* Identify target vein.
* Prepare area over vein with Povidone-iodine by applying solution in a circular motion until a area of 5cms is covered.
* Allow solution to dry for at least one minute after skin contact.
* Venepuncture and blood withdrawal using a 'no touch' technique. This may be done with the appropriate Vacutainer shield and butterfly needle or appropriate needle and syringe.
* If needle and syringe are used a new needle must be used when inoculating blood into media bottles, ie. one clean needle per bottle. Do not use needle that was used to draw blood from patient.
* Tops of media bottles must be sterilised with Povidone-iodine before inoculation with clean needles. Sterilisation of the bottle top is repeated
after needle has been withdrawn from bottle.
* Only 5-10 ml of blood should be placed into each culture bottle. For adult patients overfilling inadequate dilution leading to inadequate neutralisation. Smaller volumes decrease sensitivity. For children it is only necessary to have 1-5 ml per bottle.
Note:
Caps of bottles must never be removed from top of bottles to inoculate blood.
* If Vacutainer shield and butterfly needle are used the tops of the media bottles are prepared in the same way as per needle and syringe. After the butterfly needle has been inserted into the vein the culture bottles are then inserted into the protective shield and allowed to fill on own to desired level. Again after withdrawal of culture bottle from Vacutainer shield sterilise top of bottle with Povidone-iodine.
* Remove Povidone-iodine from patient's puncture site and ensure bleeding has stopped by applying pressure to the site.
* Send both culture bottles to the lab with the appropriate requisition forms.
* Bar codes from the two culture bottles should be placed on the requisition form.
* When placing the patient's identity labels on the culture bottles ensure that the labels do not cover the open window left where the bar codes where removed.
* Chart procedure in the patient's chart and record any difficulties or complications during procedure.
* Place time, date and type of specimen sent to lab on pathology sheet.
Ref:
Kempler, Dr ( Mar 1990), Richmond Pathology Service Handbook, 20 Jan, 1994, Collection
pg 10.
Reviewed December 1995
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