Procedure Manual
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Comment on this procedure
STANDARDS:
* Management and care of CVC at LBH may only be undertaken by a registered nurse. * Procedure should be carried out under strict aseptic technique.
* To have a uniformed approach to drawing blood cultures by trained staff. * Two sets of blood cultures consisting of two bottles per set i.e. green (aerobic) and red (anaerobes).
* Samples should be taken at least one hour apart preferably from different sites.
* Samples ideally should be drawn prior to commencement of antibiotic treatment.
* Samples should be drawn from the patients limbs when ever possible. Central Lines and Arterial Lines are used only when patients limbs are unaccessible.
* If antibiotic administration has been commenced collection at three separate sites on one occasion.
* Blood culture should be performed in every case of serious sepsis regardless of whether a primary site has been identified and sampled microbiologically.
OUTCOMES:
* Potential injury to the nurse will be minimised through proper use of equipment.
* There will be no contamination of blood samples during procedure ensure accurate results from blood sampling.
EQUIPMENT: Sterile dressing pack Rubbish bin
Povidone-iodine Blood bottles x 2; red and green topped
Eye protection 20 ml syringe/ 19G needle
Large clear vacutainer shield to accommodate blood culture bottle culture
R : 14.1
PROCEDURE:
* Explain procedure to patient prior to commencement.
* Setup dressing tray with Povidone-iodine on over bed table at patients bedside.
* Identify target vein.
* Prepare area over vein with Povidone-iodine by applying solution in a circular motion until a area of 5cms is covered.
* Allow solution to dry for at least one minute after skin contact.
* Venepuncture and blood withdrawal using a' no touch' technique, this maybe done with the appropriate Vacutainer shield and butterfly needle or appropriate needle and syringe.
* If needle and syringe are used a new needle must be used when inoculating blood into media bottles i.e. one clean needle per bottle. Do not use needle that blood was drawn from patient with.
* Tops of media bottles must be sterilized with Povidone-iodine prior to inoculation with clean needles. Sterilization of the bottle top is repeated after needle has been withdrawn from bottle.
* Only 5-10 ml of blood should be placed into each culture bottle. For adult patients overfilling inadequate dilution leading to inadequate neutralisation. Smaller volumes decrease sensitivity. For children it is only necessary to have 1-5 ml per bottle.
Note: Caps of bottles must never be removed from top of bottles to inoculate blood.
* If Vacutainer shield and butterfly needle are used the tops of the media bottles are prepared in the same way as per needle and syringe. After the butterfly needle has been inserted into the vein the culture bottles are then inserted into the protective shield and allowed to fill on own to desired level. Again after withdrawal of culture bottle from Vacutainer shield sterilize top of bottle with Povidone-iodine.
* Remove Povidone-iodine from patients puncture site and ensure bleeding has stopped by applying pressure to the site.
* Send both culture bottles to the lab with the appropriate requisition forms.
* Bar codes from the two culture bottles should be placed on the requisition form.
* When placing the patients identity labels on the culture bottles ensure that the labels do not cover the open window left where the bar codes where removed.
R : 14.2
* Chart procedure in the patients chart and record any difficulties or complications during procedure.
* Place time, date and type of specimen sent to lab on Pathology sheet.
Ref:
Kempler, Dr ( Mar 1990), Richmond Pathology Service Handbook, 20 Jan, 1994, Collection
pg 10.
Reviewed December 1995
R : 14.3
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