Blood Culture

Last Modified: 2/13/2019 2:31:20 PM


Medical Necessity Documentation:  
Client Notes: Collection Available Stat
It may be necessary to call a STAT courier if the delay is >8 hours.
Patient Preparation:  
Specimen Requirements:
Pediatric: 0.4 to 4.0 mL of blood per venipuncture drawn in Yellow Cap Bottle

Adults: Blood Culture Set (20 mL of blood per venipuncture drawn - 10 mL per bottle) 
 Aerobic Blue Cap Bottle (higher priority) and Anaerobic Purple Cap Bottle use only if aerobic bottle is filled.   
Collection Instructions:

For collection Instructional Sheet see Addendum D

Obtain two blood samples from two separate sites.One draw immediately following the other unless orders are written otherwise.

If endocarditis is suspected, obtain four sets initially on two separate days when antibiotics are not given, or all four on same day when antibiotics are to be given that day.

Draw at any time, not necessarily in relation to level of fever.

When using a butterfly needle for collection, the aerobic bottle should be collected first. This will ensure that air in the butterfly tubing does not enter the anaerobic bottle. 

Select a different site for each culture drawn.

Avoid drawing blood through an indwelling catheter whenever possible. However, if required one set should be drawn from a peripheral vein and the second from the line.

Always indicate if specimen is from a line draw. 

Please indicate any prior antibiotic therapy. 

Iodine (betadine) is used if it is a collection on a 2month old or younger

  1. Identify the patient according to the “Patient Identification, Specimen Collection, Labeling and Testing,”  
  1. Remove the plastic caps from the top of each blood culture bottle. 
  1. Sterilize the exposed rubber septum with alcohol by rubbing vigorously and allowing it to dry before entering the bottle.  
  1. Wash and dry your hands thoroughly and observe Standard Precautions. 
  1. Apply gloves.  
  1. Apply tourniquet and choose the site for venipuncture.  
  1. Remove tourniquet until ready to proceed with the actual venipuncture. Leaving the tourniquet on the patient’s arm for more than 1 minute causes discomfort for the patient and hemoconcentration which can affect lab results.  
  1. Prepare the venipuncture site with an alcohol prep using concentric circles. 
  1. Wipe with Chlorahexidine using concentric circles and allow drying for 30 seconds. Note: For patients less than two months of age, Betadine should replace Chlorahexidine, and should be removed from the skin with alcohol. 
  1. Remove the butterfly set from the package.  
Note: If it is necessary to draw blood with a syringe (e.g., infant draw or the patient has fragile veins), a butterfly should be attached to the syringe to maintain safety. Detach the removable needle (covered with a gray rubber sheath), used for the vacuum system. After collecting the blood in the syringe, detach the butterfly needle. Attach the Angel Wing Blood Collection device or a BD Blood Transfer Device to transfer the blood into the culture bottle.   
  1. Connect the BacT/Alert adapter cap to the luer of the butterfly. 
  1. Perform the venipuncture using an aseptic procedure and according to the venipuncture procedure. The phlebotomist should not palpate the vein after skin disinfection unless a sterile glove is worn.  
  1. When blood appears in the butterfly tubing, place the adapter cap on the top of the aerobic blood culture bottle, which will allow the needle to penetrate the bottle septum.    
  1. While holding the adapter cap down on the bottle, allow bottle to fill to the 10 ml mark. Ensure that the bottle is placed below the venipuncture site to ensure proper filling of the blood culture bottle. Note: Underfilling or overfilling the bottles may cause false results.  
  1. With the needle still in the patient’s vein, remove the aerobic bottle and place the adapter cap on the anaerobic bottle.  Follow step M and allow filling. 
  1. If only blood cultures are ordered, remove the adapter cap from the anaerobic bottle, then remove the butterfly needle from the venipuncture site.  This will ensure that no air is allowed to enter the anaerobic bottle. NOTE: When transferring blood from a syringe, the anaerobic bottle should be filled first and the syringe removed before all blood is expelled to prevent air from entering the bottle.   
  1. If additional blood is required for other tests, place the adapter insert into the adapter cap and lock into place.  This allows the cap to be compatible with vacuum collection tubes thus additional tubes can be drawn without additional venipunctures. 
  1. Label blood culture bottle(s) and any additional tubes according to “Patient Identification, Specimen Collection and Labeling.” (procedure #4213) Do NOT place labels over the barcodes or the blood volume window that are present on the blood culture bottles.  
  1. Transport the fungal blood culture specimens to the laboratory within two hours (stat courier may be necessary or collection at a hospital site). Delays in timely transport of blood culture bottles may delay or impede detection of growth. 


BioMeriux Videos to aid in the collection of Blood Cultures: 
Transport & Storage: Temperature/Stability: Blood cultures must be transported to the Microbiology Department at PRMC as soon as possible after collection; ≤ 4 hours from collection is best. 

Ambient
Reference Range:

No Growth Detected

Critical Ranges: Positive primary culture
Test Comments: Appropriate identification and determination of organism susceptibility to appropriate antimicrobial agents will be performed

Positive results are reported Immediately.
Preliminary results are reported at 24 and 48 hours
No growth results are reported at 5 days

Recollection will be recommended if inadequate volume is obtained. The volume of blood is critical because the concentration of organisms in most bacteremias is low, especially if the patient is on antimicrobial therapy.
Methodology: BacTAlert 3D Microbial Detection Continuous System
Clinical Significance:  
Documentation: See also Fungus Culture and Mycobacteria (AFB)
Custom Panel: No

PRODUCTION SCHEDULE

Turn Around Time: 5 days
Days Performed: Sunday, Monday, Tuesday, Wednesday, Thursday, Friday, Saturday
Sites Performed: Parkview Regional Medical Center
PHL Test Code: CXBLD
EPIC Test Code: LAB462
Alternate Test Names: Culture, Blood
Included Tests: Blood Culture; Organism ID if indicated; Susceptibility if indicated
CPT Coding: 87040 (Reflexes 87186, 87077)

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