Blood Culture Procedure for CVL

Norman Swope BSN, RN Infection Control Resource NurseUniversity of Arkansas for the Medical Sciences

Purpose/ GoalsTo provide initial education for new nurses.To provide a refresher for veteran nurses.To ensure the proper procedure in

performing task.To prevent unnecessary contamination and

additional blood draws.

Gather and Inspect your supplies/ ID your patient(2ways).EQUIPMENT: 2 sets of B.C. = 4 bottles2 Blood Culture Kits (available from Distribution Center/Central

Supply) containing: · Blood culture (skin) prep/Chloraprep · Biohazard Bag · Aerobic bottle (Blue Bottle) · Anaerobic bottle (Red Bottle) · Blood culture bottle adapter · Alcohol applicatorA cap (needleless valve) for each lumen used for obtaining blood

culturePatient Lab specimen labelsGloves

Change and Clean Infusion Caps1. Get a secure grip on leur-lock cap. 2. Remove old cap.3. Clean if visibly soiled with chlorhexadine(CHG)

scrub, otherwise attach new clean cap. 4. Clean the cap with Chloraprep before drawing

culture. KEYPOINT: If drawing from central or arterial line, change the

cap (needleless valve) before obtaining blood. Clean each new infusion cap (needleless valve) or leur-lock connection with a separate blood culture Chloraprep. Allow to dry before collecting blood.

Use sterile/ aseptic techniqueDid you know that the replacement caps are

sterile?Did you know that the adapter needles are

sterile?Set up and clean your work area.Wash your hands before you begin.

Cleaning Culture BottleVigorously wipe septa of the blood culture bottles

(or Isolator tube) with 70% alcohol. Keep septa covered at all times before injecting blood with alcohol prep pad to prevent airborne containments away from septa.

KEYPOINT: The septum of the blood culture bottle (or Isolator tube) is not sterile and must be disinfected before injecting blood.

15-20 seconds

Leave them there until used.

Setting up the Multi-vial Adapter and drawing specimens. At the bedside attach Blue/White needle to the multi-vial adapter.

(Butterfly needles are not approved for CVL culture draws.) Clean the lumen to be used for 30 seconds with CHG swab then

allow to dry for 30 seconds. Vigorously wipe septa of the blood culture bottles (or Isolator

tube) with 70% alcohol. Keep septa covered at all times before injecting blood with alcohol prep pad to prevent airborne containments away from septa.

4. Apply gloves and collect a full 10 ml per bottle (adults) KEYPOINT: The septum of the blood culture bottle (or Isolator

tube) is not sterile and must be disinfected before injecting blood.

Drawing blood culture cont. If drawing with a syringe, either directly or from a central line, then you must inject the pink topped Anaerobic tube first then the blue topped Aerobic tube last.

Flush per unit protocol when competed.KEYPOINT: If drawing with a winged butterfly set you

must inject the blue topped Aerobic (Blue) bottle first then the purple topped Anaerobic (Pink)bottle.

Do Not waste any blood.

Anaerobic (red)is 1st for CVL.

Aerobic (blue) is 1st for Peripheral.

Label the vial and the transmittal.Fill out microbiology specimen transmission slip or Sunrise

transmission slip. Always sign the slip and have another person verify the label with the transmission slip and sign the form.

Bottles should be labeled and patient verified at bedside.Send to lab As Soon As Possible!KEYPOINT: Put your initials, color of lumen, time and date

drawn on slip and on the Blood Culture bottle.

REFERENCES: http://intranet.uams.edu/nursingmanual/Procedures/

procedure108.htmIsenberg, H. (editor in chief), Clinical Microbiology

Procedures Handbook, 2nd edition, (2005). pp. 3.4.1.2-3.4.1.4,

Mathew, A. et al. (2009). Central catheter blood sampling: The impact of changing the needleless caps prior to collection. Journal of Infusion Nursing, 32(4): 212-218.

National Institute for Health and Clinical Excellence. (2007). Blood Cultures. Retrieved July 23, 2009 from http://www.pathology.leedsth.nhs.uk/pathology/Departments/MicrobiologyVirology/How2Sample/BloodCultures/tabid/158/Default.aspx