c5-BLOOD CULTURES.docx

BLOOD CULTURES ============== Blood cultures are laboratory tests used to check for bacteria or other micro-organisms in a blood sample. Providers order this test to assist in diagnosing conditions in patients who have a fever of unknown origin (FUO). If you work in a hospital-especially one with...

BLOOD CULTURES ============== Blood cultures are laboratory tests used to check for bacteria or other micro-organisms in a blood sample. Providers order this test to assist in diagnosing conditions in patients who have a fever of unknown origin (FUO). If you work in a hospital-especially one with a busy emergency department-you might receive several blood culture requisitions. The blood sample is sent to a laboratory, where it is processed, placed into a specialized dish, and observed to see whether micro-organisms grow. (This is the actual culture process.) If this occurs, further tests will be done to identify the specific micro-organisms present in the blood sample. Steps to perform a blood culture: 1. Introduce yourself. 2. Properly identify the patient as you would with any blood collection, using at least two patient identifiers. 3. Wash hands, and don gloves. 4. Assemble supplies, including a winged infusion set or syringe needle, adapter, and blood culture collection bottles. You will need one set of blood culture bottles per collection (one aerobic and one anaerobic). 5. Review the medical requisition form to determine how much blood needs to be collected. 6. Mark blood collection bottles with the level of blood required. 7. Remove the protective cap (making sure to avoid removing the entire cap), and cleanse the top of the blood collection bottles with an antiseptic (alcohol). 8. Apply a tourniquet. 9. Palpate to find an accessible blood vessel. Then remove the tourniquet while you prepare the skin. 10. Protocols for blood culture antisepsis vary. Be sure to follow the manufacturer\'s recommendations. An acceptable method is to cleanse the intended area of venipuncture with 70% isopropyl alcohol with a friction scrub. 11. Allow the area to dry completely. 12. Cleanse the area again for 30 to 60 seconds using the main disinfectant (chlorhexidine gluconate or povidone-iodine). 13. Do not touch this area after it has been cleansed. Allow it to dry completely. 14. Reapply the tourniquet after you are sure the area has dried. 15. Ask the patient to clench their hand into a fist. 16. Stretch the skin downward below the collection site, using the thumb of your nondominant hand to anchor the vein in place. 17. Quickly insert the needle into the vein at a 15° to 30° angle with the bevel facing up. Pop the blood culture bottle onto the double-pointed needle. (If the blood culture set includes aerobic and anaerobic, collect the anaerobic first if using a syringe. If a butterfly needle is used, collect the aerobic first.) 18. Have the patient unclench their fist as blood enters the tube or bottle. 19. As each tube is removed from the needle holder, gently invert to properly mix the specimen. 20. Remove the tourniquet before 1 min. 21. Monitor the patient's condition. 22. Make sure not to disturb the needle's position as tubes fill. 23. If there are more evacuated tube system (ETS) tubes to be collected) proceed to collect them in the proper order of draw. 24. Quickly remove the needle using the same angle as insertion. 25. Apply gauze) using pressure) to the puncture site. 26. Activate the safety device so that the needle is immediately covered. 27. Dispose of the entire needle assembly into a sharps container. 28. Make sure that the vein is not leaking by conducting a two-point check, observing the site for up to 10 seconds after releasing pressure and removing the gauze. If visible bleeding occurs (or if the surrounding tissue rises), keep applying pressure until bleeding stops. 29. Apply a bandage or tape clean gauze over the puncture site. 30. Label all blood collection bottles and tubes before leaving the patient. 31. Check the patient's status again. 32. Leave the room or dismiss the patient. ASSISTING OTHER HEALTH PROFESSIONALS WITH SPECIMEN COLLECTIONS ============================================================== Sometimes, other health care professionals need to assist with blood culture collections. This can involve notifying the proper laboratory personnel when the culture is to be collected, assembling all needed materials, and explaining procedures to patients. If two blood cultures are going to be drawn on the same patient, make sure to have two complete sets of all equipment necessary. Do not reuse antiseptic pads, gauze, or needles. Use new supplies for both blood culture collections. When assisting with blood cultures, you may perform the following actions. 1. Obtain and label proper tubes or bottles. 2. Carefully wash hands before the procedure. 3. Observe standard precautions by putting on gloves as well as providing gloves for the person you are assisting. 4. Place a protective pad under the patient's arm. 5. Prepare the patient's skin with at least two antiseptic wipes and cleanse the area twice. 6. Assist in the venipuncture process. 7. Assist with applying pressure bandages to venipuncture sites upon completion of the procedure. 8. Check the patient a few minutes later to make sure bleeding has stopped. 9. Assist with proper disposal of all supplies. 10. Document that the procedure was done, including the date, time and who performed it. 11. Immediately take the specimens to the laboratory. (Inappropriate growth can occur if specimens are not handled correctly.) 12. Ensure you have two blood culture bottles: one aerobic and one anaerobic.