BLOOD CULTURE COLLECTION 
                              
            POLICY 
            A physician's written order is required for the drawing of a blood culture.  
            Blood cultures are drawn: 
                 1.  to rule out suspected infection  
                 2.  as surveillance monitoring of current infection 
            Timely collection is critical prior to initiation of treatment and should occur within one hour of given order. 
            A registered nurse certified in the initiation of IVs may collect a blood culture by performing a venipuncture 
            or when initiating placement of an IV cannula. Note: In IN, blood cultures are routinely taken by a Lab 
            technician.  
            A blood culture may also be taken from a centrally placed venous line. For collection of blood culture from 
            CVL, see NICU CVL manual. A blood culture can be drawn from umbilical/peripheral arterial line at the time 
            of insertion.  
            Adherence to skin disinfection is essential to the collection of a blood culture.  
            PROCEDURE  
                      
            Gather Equipment  
                 1.  Aerobic (Peds Plus) culture bottle (check expiry date, discard outdated bottles) 
                 2.  Dexidin 2 solution (2% chlorhexidine gluconate with 4% isopropyl alcohol solution) 
                 3.  Sterile Q-tip or gauze 
                 4.  Microbiology requisition and patient label  
                 5.  #24 over-needle cannula device/ butterfly #23 or#25 gauge  
                 6.  #18 gauge needle  
                 7.  3 mL syringe 
                 8.  Sterile gloves  
                 9.  Chlorhexidine swab (2% chlorhexidine with 70% alcohol swab) to disinfect blood culture bottle top 
                 10. Tegaderm to secure IV 
                 11. Save-a-day tray (to carry supplies) 
             
              Procedure                                                    Notes  
              1.  Collect equipment/supplies.                              Anaerobic blood cultures are rarely indicated.  
                                                                           If required use Bactec Lytic (purple cap) bottle.  
              2.  Wash hands.                                               
               
              3.  Position and safely restrain infant.                     Second caregiver should be utilized to optimize 
                                                                           comfort and success. 
              4.  Glove.                                                   Touching prepared site prior to the skin puncture 
                                                                           to locate the vein is the most common cause of 
                                                                           contamination. Sterile gloves are required 
                                                                           unless a no-touch technique is used.  
              5.  Cleanse skin site with Dexidin 2 solution using          Per NICU P&P on cleaning protocol for skin. 
                 side-to-side motion for minimum of 30 seconds             For infants ≤ 1000gm: 
                 (30-60 seconds).  Allow to air dry for 60 seconds.        Remove residual dexidin solution on skin using 
                                                                           sterile normal saline or sterile water after blood 
                                                                           culture procedure is complete. 
              6.  Perform venipuncture.                                     
              a.  Insert/assist with insertion of IV device.               Insert IV as per NICU P&P: Intravenous 
            Policy NN.16.01                          Neonatal Program Policy & Procedure Manual                       Effective Date: 01-MAY-2007 
                                                                                                                       Page 1 of 3 
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                                                             BLOOD CULTURE COLLECTION 
                              
              Procedure                                                    Notes  
              b.  Once flashback is seen                                   Initiation of Steel butterfy or Over-the-needle 
                Jelco or insyte – remove stylette and aspirate            Cannula. 
                 blood gently with #18 gauge needle attached to 3           
                 ml syringe                                                Be aware of potential for needle stick injury.  
                Butterfly – aspirate blood gently with syringe             
                 attached to end of the butterfly                           
              c. Aseptically collect minimum of 0.4ml into single           
              Peds Plus culture bottle. If this is a collection to          
              follow-up a positive culture, 0.6ml will be required.   
              d. Withdraw needle and apply pressure to the                 Pressure applied to puncture site alleviates 
              puncture site with gauze for 2-3 minutes                     bruising, hematoma and discomfort associated 
                                               OR                          with both. If hematoma develops, apply warm 
              Secure cannula and initiate IV fluid infusion.               soaks to the site. 
                                                                            
              7.  Remove caps from the culture media bottles.              The cap does not form an airtight seal therefore 
                                                                           the stopper may not be clean. 
              8.  Cleanse rubber stopper on culture media bottle           To disinfect: scrub for 30 seconds and allow to 
                 with a chlorhexidine/alcohol swab.                        air dry for 60 seconds. 
              9.  Inject the required amount of blood into culture         Do not forcefully evacuate blood from a syringe 
                 media bottle.                                             into culture bottle. Increases risk of exposure if 
                                                                           specimen splatters.  
                                                                           There is no need to change needle prior to 
                                                                           instilling in culture bottle.   
                                                                            
              10. Place completed patient label around neck of             Label to include:  
                 bottle.                                                     date, time and initials.  
                                                                           Avoid covering scanning bar and adjacent 
                                                                           sequence numbers on original bottle label. 
              11. Complete microbiology requisition.                       Include on requisition:  
                                                                             date and time of collection,  
                                                                             type of culture requested (if yeast suspected, 
                                                                              write C&S and yeast),  
                                                                             diagnosis  
                                                                             person drawing cultures.  
                                                                           If collected from a CVL ensure correct lumen 
                                                                           identified.  
              12. Clean the outside of the specimen   containers if        Supports principles of universal precautions and 
                 contaminated with blood using diluted Bleach              protection of staff handling the specimen. 
                 solution available outside reception desk area. 
              13. Place specimens in container a front desk and            Immediate transport to lab is recommended.  
                 inform unit clerk.                                        Do not refrigerate specimen. 
             
            DOCMENTATION  
            Policy NN.16.01                          Neonatal Program Policy & Procedure Manual                       Effective Date: 01-MAY-2007 
                                                                                                                       Page 2 of 3 
                                       Refer to online version – Print copy may not be current – Discard after use 
             
                                                                                 
                                                                                 
                                                            BLOOD CULTURE COLLECTION 
                             
            On Nurses flowsheet: 
               Name of physician or nurse taking sample 
               Any procedural complications 
               Amount of blood collected, specifying type of culture obtained. i.e. yeast 
               Infant tolerance 
                     
            REFERENCES  
            LINKS TO CARE PLANS:  Intravenous Insertion of Steel Butterfly 
            BCCH, Microbiology Procedure Manual. Blood Culture Collection Protocol.  January 2007. 
                                                         nd
            Daly, S.et al. (1996) Nursing procedures (2  Ed.) 138, 139. Springhouse, Pennsylvania.  
            Fatter, G. (1997) Int. J Clin Lab Res. 27(4): 238-43. 
            Lund CH et al. (2001) Neonatal skin care: Evaluation of the AWHONN/NANN research-based practice 
            project on knowledge and skin care practices. Association of Women’s Health, Obstetric and Neonatal 
            Nurses/National Association of Neonatal Nurses. JOGGN. 30(1):30-40. 
            National Committee for Clinical Laboratory Standards. (1998) Procedures for the collection of diagnostic 
            blood specimens by venipuncture. Approved Standard, H3-A4, Villanova, PA. 
            Smart, D. et al. (1993) Effect of Needle Changing and Intravenous Cannula Collection on Blood Culture 
            Contamination Rates. Ann Emerg Med. 22(7): 1164 – 8. 
                                                                        th
            Wong, D. (1995). Nursing Care of Infants and Children (5  Ed.) pp. 1177. St. Louis: Mosby – Year Book.  
                     
            Policy NN.16.01                         Neonatal Program Policy & Procedure Manual                       Effective Date: 01-MAY-2007 
                                                                                                                   Page 3 of 3 
                                      Refer to online version – Print copy may not be current – Discard after use