Lab Test Procedure : Blood Cultures, Line Draws

Policy Tech Version 1

Blood Culture Collection, Line Draw

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:

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.

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.

8. 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. 4/2013
Package Insert BacT/Alert FN+ Ref 410852. 4/2013
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.
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

(revised 3-25-15)

 

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