Blood Cultures, Line Draws

 

Policy Tech: Version 3

 

Special Notes: To prevent specimen contamination by microorganisms, use sterile supplies and

aseptic technique to collect specimens. Obtain cultures prior to starting antibiotic therapy.

Notify the physician if unable to obtain cultures.

Line draws include: Central Venous Access Device (CVAD) including tunneled and non-tunneled

catheters (e.g. PICC, implanted ports, Broviac)

Supplies

 Huber needle (if implanted port)

 10ml syringe for specimen

 Chlorhexidine Prep

 70% isopropyl alcohol pad

 Clean gloves

 Mask

 Sterile 4 x 4 gauze

 Sterile fill-needle

 Normal saline flush

 Heparin flush, if not infusing through the line

 Sterile injection cap

 Culture bottles anaerobic (orange) and aerobic (green)

Blood Culture Media (always consider patient’s weight when choosing appropriate bottles:

Green Aerobic Bottle FA+: 1 mL minimum to 10 ml maximum (See Weight Chart)

Orange Anaerobic Bottle FN+: 2 mL minimum to 10 maximum (See Weight Chart)

Collection Procedure:

Steps

Careful attention to the technique of obtaining blood from the CVAD must be observed. Risks of

CVAD blood sampling:

 Increased risk of central line-associated blood stream infection (CLABSI)

 Increased risk of catheter occlusion

Through Injection Cap technique (preferred for CLA-BSI prevention)

1. Consider a two-person technique to permit one person to draw and flush the central line

and one person to transfer the specimen.

2. Stop infusion, as needed.

3. Perform hand hygiene.

4. Don clean gloves.

5. Remove alcohol-impregnated cap or scrub the hub with alcohol for 15 seconds.

6. Let air day (about 15 seconds).

7. Attach 10 ml syringe to injection cap.

8. Draw required volume (no discard) from each central line. Contact Lab is unable to collect

the minimum specimen volume.

9. Remove tops of blood culture bottles. Clean bottle top with 70% isopropyl alcohol and allow

to air dry.

10. Technique

   a. One person technique:

    i. Place a sterile fill-needle on the end of the syringe of blood.

    ii. Flush the line with saline.

    iii. Connect the infusion or flush injection cap with heparin and place a new

alcohol-impregnated cap.

    iv. Inject blood specimens into bottles. Indicate central line draw (by color for

multi-lumen tunneled catheters and by side of port for multi-lumen

implanted ports) or peripheral line.

    v. Be careful, the pressurized bottles will aspirate all of the blood from the

syringe unless you control the flow with your thumb and index finger.

Optimal blood amounts are necessary or you will have decreased sensitivity

that may delay time detection of a true positive blood culture.

   b. Two person technique:

     i. Person one

1. Flush the line with saline.

2. Connect the infusion or flush injection cap with heparin and place a

new alcohol-impregnated.

    ii. Person two

1. Inject blood specimens into bottles

2. Be careful, the pressurized bottles will aspirate all of the blood from

the syringe unless you control the flow with your thumb and index

finger. Optimal blood amounts are necessary or you will have

decreased sensitivity that may delay time detection of a true positive

blood culture.

3. Order to place specimen into the specimen bottles:

  a. anaerobic (purple) bottle, then

  b. aerobic (yellow or green depending on patient's weight) bottle

  c. If you only have enough blood for one bottle, place the

specimen in the aerobic (yellow or green) bottle.

4. Label bottles. Indicate central line draw (by color for multi-lumen

tunneled catheters and by side of port for multi-lumen implanted

ports) or peripheral line.

5. Discard needle and syringe into sharps container.

6. Remove gloves and perform hand hygiene.

7. Send specimens promptly to Lab (use pneumatic tube system). Never

refrigerate a blood culture specimen.

  a. Inpatient units: Send the audit trail with specimen that

includes initials/EE number of person drawing the specimen,

date, time and type of line/lumen.

11. Injection cap change

  a. Infrequent blood draws: Change the injection cap

  b. Frequent daily blood draws: Change the injection cap daily

References:

Bowden, V.R., Smith Greenberg, C.(2008). Pediatric Nursing Procedures, 2nd Ed. Philadelphia:

Wolters

Kluwer/Lippincott Williams & Wilkins.

Isenberg, H.D. (2004). Clinical Microbiology Procedures Handbook, Volume 2. Washington, D.C.:

The ASM

Press.

Package Insert BacT/Alert FA+ Ref 410851. 04/2016

Package Insert BacT/Alert FN+ Ref 410852. 04/2016

Broder-Fingert S, Crowley WF, Jr., Boepple PA. (2009) Safety of frequent venous blood sampling

in a pediatric research population. Journal of Pediatrics, 154(4), 578-581.

Infusion Nurses Society. (2011). Infusion Nursing Standards of Practice, 34, Untreed Reads.

LTD- Blood Cultures: Specimen Collection, Line Draw Version 3, Minor Revisions, 6/18/19 Page 4

Mermel LA, Allon M, Bouza E, et al. (2009). Clinical practice guidelines for the diagnosis and

management of intravascular catheter-related infection: 2009 Update by the Infectious

Diseases Society of America. Clin Infect Diseases, 49(1), 1-45.

 

Blood culture recommended volume based on patient weight

 

Patient weight in Kg	Blood volume to collect	Media type and  inoculation volume
		Aerobic (green FA plus)	Anaerobic (orange FN Plus)
1 to 3  (<6.6 lbs.)	1ml	1 ml
3.1 to 6 (6.6-13 lbs)	2ml	2 ml
6.1 to 9 (13-20 lbs)	4 ml	4 ml
9.1 to 12 (20-26 lbs)	6ml	4 ml	2 ml
12.1 to 20 (26-44 lbs)	8ml	4 ml	4 ml
20.1 to 25 (44-55 lbs)	10ml	5 ml	5 ml
25.1 to 40 (55-88 lbs)	15ml	10ml	5 ml
> 40 (>88 lbs)	20ml	10ml	10 ml