Blood Culture Sampling in Adults - Standard Operating Procedure for

Publication: 01/11/2007  
Last review: 23/11/2017  
Next review: 23/11/2020  
Standard Operating Procedure
CURRENT 
ID: 1207 
Approved By: Improving Antimicrobial Prescribing Group 
Copyright© Leeds Teaching Hospitals NHS Trust 2017  

 

This Standard Operating Procedure is intended for use by healthcare professionals within Leeds unless otherwise stated.
For healthcare professionals in other trusts, please ensure that you consult relevant local and national guidance.

Please check the patients allergy status, as they may be allergic to Chlorhexidine, and alternative ( Providine iodine) solution will be required.
Be aware: Chlorhexidine is considered an environmental allergen.
Refer to the asepsis guidance.

Standard Operating Procedure for Blood Culture Sampling in Adults  

Obtaining bloods for culture

Blood samples for culture should be obtained whenever bloodstream infection is clinically suspected. If the patient has an indwelling vascular catheter, then paired ( peripheral (Protocol A)  and line(Protocol B)) blood cultures should be obtained within 30 minutes of each other.  The clinical features of bloodstream infection are varied and are not confined to a febrile illness. Blood cultures should only be taken when the results will directly affect patient management and may not be appropriate in some situations; for example patients on the end of life care pathway.

Please refer to the Severe Sepsis Screening Tool and Resuscitation care Bundle (Adults) or Neonatal Sepsis Guidelines for advice on how to identify and appropriately respond to sepsis, including when to take blood cultures.

Procedure method (step by step)

Blood culture technique for sampling from a peripheral vein in adults.

Do not use existing peripheral cannula or sites immediately above peripheral cannula.

A newly inserted cannula should only be used if a risk assessment has concluded that further peripheral venepuncture is not a suitable alternative e.g. needle phobia, patient non-compliance, etc.
If following assessment the patient is considered to be restless, agitated or confused, gain assistance from a second person for the procedure.

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Protocol A. Using a needle safe vacuum-assisted blood collection system

Patient and equipment preparation.

  • Wash hands with soap and water, in accordance with LTHT Hand Hygiene policy.
  • Identify the correct patient e.g. check name band and verbally confirm identity, explain the procedure and obtain verbal consent where appropriate.
  • Clean the dedicated IV procedure trolley from top to bottom with detergent wipes and allow to dry.
  • Ensure you have all the equipment you will require. Check expiry dates and that packaging is intact.
  • Please use the BUFALO pack. Which contains

 

Vacuette Safety Blood Collection System 23g

Chloraprep Sepp 0.67mls

Adult Blue Band Torniquet

2% CHG Sani Cloth

White Paper Towel

Yellow Bag

Gauze Swab

Strip of tape approx 5cm

Blood Culture Bottles

Documentation -BUFALO adult intervention tool sticker and  blood culture label.

You will also need,

Sterile gloves

Apron

Sanitiser dispenser

Point of care sharps bin - preferable attached to the IV trolley

Take your prepared trolley to the patient bedside.
Skin preparation

  • Perform hand hygiene in accordance with LTHT Hand Hygiene policy and put on apron.
  • Open a dressing pack carefully ensuring only the corners are touched with your un-gloved hands to create a sterile field on the trolley. Secure yellow waste bag ready for use. Carefully open the safety collection device and drop onto the sterile field.
  • Select a venepuncture site (NB Use the femoral vein only if venepuncture is not possible at other sites). If using femoral site clean the skin with soap and water, dry prior to decontamination; a 3ml SEPP will be required to clean the groin area.)
  • Position the patient comfortably so selected site is easily accessible. Clean the venepuncture site using the Chloraprep Sepp. Apply with a cross hatch technique for at least 30 seconds. Allow to air dry (the drying process kills the bacteria).
  • Perform hand hygiene in accordance with LTHT Hand Hygiene  policy
  • To avoid cross contamination from the collectors fingers it is important not to re-palpate the site once it has been disinfected.

Sample collection

  • Disinfect the non-sterile rubber tops of blood culture bottles using a swab containing 2% chlorhexidine in 70% alcohol (sani-cloth CHG 2%) and place bottles to the side of the sterile field, not on it.
  • Apply a single patient use tourniquet at this point if required. Ensure you do not re-palpate your disinfected venepuncture site with ungloved hands.
  • Perform hand hygiene in accordance with LTHT Hand Hygiene in policy.
  • Put on sterile gloves.
  • Perform venepuncture ensuring asepsis is maintained and secure butterfly needle to the patient’s skin with clean tape to ensure two hands are free to collect the sample. At this point your gloves are no longer sterile so do not touch venepuncture site or bottle tops.
  • With the blood culture bottle held upright insert the aerobic bottle into the tube holder of the safety blood collection set. Once the sample has reached the pre-marked fill level remove the bottle and repeat with the anaerobic bottle.
  • Remove tourniquet.
  • Place a swab over the venepuncture site and activate the safety feature of the safety blood collection set whilst applying gentle pressure to the puncture site. Press firmly over the venepuncture site until bleeding has ceased; the patient can be asked to do this if appropriate. Discard the needle into a sharps bin and remaining sterile pack in to clinical waste appropriately.
  • Remove apron and gloves, dispose into clinical waste bag, perform hand hygiene in accordance with LTHT Hand Hygiene  policy.
  • Clean trolley and return to dedicated storage area ensuring it is restocked if required.

If it is not possible to fill one or both bottles with the correct volume of blood, repeat the above procedure at a different venepuncture site.
If sterility is compromised at any stage during the procedure dispose of sample and repeat. A potentially contaminated sample must never be used to direct antimicrobial therapy.
Labelling and transport

  1. Use labels from ordercoms system. Ensuring details and clinical information on blood culture bottles according to local labeling policy. Ensure clinical information includes sampling site and time sample was taken.
  2. Arrange prompt transport of the sample to the laboratory.
    N.B. The  Biomerieux blood culture bottles can be sent through the air tube.
  3. Ensure that sampling details and any subsequent positive results communicated by the microbiology department are accurately documented in the patient’s notes and advice is acted on.

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Protocol B. Technique for “paired” blood culture sampling to diagnose vascular catheter infection.

Preface

  1. Sample blood via a peripheral vein as in Protocol A ensuring 10mls of blood is inoculated into each blood culture bottle, inoculate the aerobic blood culture first.
  2. Record the volume of blood inoculated  into each blood culture bottle, the time inoculated and label both request form and blood culture bottles as “peripheral”.
  3.  As soon as possible, at least within 30 minutes of collecting the peripheral blood sample collect “through line” samples following Protocol B. Ensure the same volume of blood (that was inoculated into the peripheral set) is inoculated into the through-line sets and that the aerobic bottle is inoculated first.
  4. Stop all infusion/perfusion pumps and close all infusions, unless discontinuing an infusion is contra-indicated.
  5. Obtain “through line” blood samples from every lumen of potentially infected catheters, wherever possible. 
  6. Record the volume of blood inoculated into each blood culture bottle, the time inoculated and label both request form and blood culture bottles as “Catheter [indicate lumen]”.

Patient and equipment preparation for obtaining blood for cultures from a central venous catheter.

  1. Wash hands with soap and water, then dry hands in accordance with LTHT Hand Hygiene  policy.
  2. Identify the correct patient e.g. check name band and verbally confirm identity where possible, explain the procedure and obtain verbal consent where appropriate.
  3. Clean the dedicated IV procedure trolleys from top to bottom with detergent wipes and allow to dry (the drying process kills the bacteria).
  4. Ensure you have all the equipment you will require.

Buffalo pack containing;

Vacuette Safety Blood Collection System 23g

Chloraprep Sepp 0.67mls

Adult Blue Band Torniquet

2% CHG Sani Cloth

White Paper Towel

Yellow Bag

Gauze Swab

Strip of tape approx 5cm

Blood Culture Bottles

Documentation -BUFALO adult intervention tool sticker and  blood culture label.

You will also need,

  • Apron and gloves.
  • Holdex collection system.
  • Saline flushes 10 ml.
  • Sanitiser dispenser.
  • Point of use sharps bin - preferable attached to the trolley.
  1. Take your prepared trolley to the patient bedside.
  2. At your designated IV preparation area draw up the required number of 0.9% sodium chloride flushes (10ml) using a Aseptic Non Touch Technique (ANTT) and place in dedicated clean tray. See guidelines for Accessing an intravenous device to administer IV medication. For more information on ANTT please see Asepsis Policy. Ensure all flushes are prescribed and second checked as per LTHT Medicines Management Policy.

“Through line” sample collection

  1. Open a dressing pack carefully ensuring only the corners are touched with your un-gloved hands to create a sterile field on the trolley. Secure yellow waste bag ready for use. Carefully open the safety collection device and drop onto the sterile field.
  2. Wipe the rubber bungs of the blood culture bottle with the Sani-cloth CHG 2%) and place on top of the trolley.
  3. Perform hand hygiene in accordance with LTHT Hand Hygiene  policy
  4. Put on clean gloves; these do not need to be sterile. This is an aseptic non-touch technique procedure.
  5. Holding the line up with one hand scrub the hub of the lumen with a 2.0 % chlorhexidine in 70% isopropyl alcohol wipe (Sani-cloth CHG 2%). Keep holding the hub while you allow 30 seconds for it to dry.
  6. Attach a sterile in-situ line collection system (holdex) to the decontaminated needle free hub using an aseptic non-touch technique. Be careful not to touch the tip of the collection device.
  7. With the blood culture bottle held upright insert the aerobic bottle into the collection device. Once the sample has reached the pre-marked fill level remove the bottle and repeat with the anaerobic bottle. It is not necessary to discard the initial fluid in the lumen unless it is likely to contain an antibiotic.
  8. Using a non-touch technique flush the line with 0.9% saline.
  9. Holding the line up with one hand scrub the hub of the lumen with a 2.0 % chlorhexidine in 70% isopropyl alcohol wipe again (Sani-cloth CHG 2%). Keep holding the hub while you allow 30 seconds for it to dry.
  10. Repeat process for each of the lumen being sampled.
  11. Discard the collection systems into a point of use sharps bin and dispose of clinical waste appropriately.
  12. Remove gloves and perform hand hygiene in accordance with LTHT Hand Hygiene  policy.
  13. Clean trolley and return to dedicated storage area ensuring it is restocked if required.

If sterility is compromised at any stage during the procedure dispose of sample and repeat. A potentially contaminated sample must never be used to direct antimicrobial therapy.
Labelling & transport

  1.  Patient details and clinical information to be put on blood culture bottles according to local labelling policy. Ensure clinical information includes sampling site and time sample was taken
  2. Arrange transport of the sample to the laboratory.
    N.B. The  Biomerieux blood culture bottles can be sent through the air tube.
  3. Ensure that sampling details and any subsequent positive results communicated by the microbiology department are accurately documented in the patient’s notes and advice is acted on.
  4. Remember to replace all administration sets and infusion sets that have been disconnected in this process and re-start any infusions.

In addition to the usual clinical indications for blood culture sampling, blood cultures should now also be taken prior to starting any intravenous antibiotic treatment course.

Provenance

Record: 1207
Objective:

Aims

  • To standardise and optimise the blood culture technique for sampling from a peripheral vein in adults.
  • To standardise and optimise blood culture technique for diagnosis of intravascular catheter-related bloodstream infection.
Clinical condition:
Target patient group: Adults
Target professional group(s): Secondary Care Doctors
Secondary Care Nurses
Adapted from:

Evidence base

  1. Calfee D.P., Farr B.M. (2002) Comparison of Four Antiseptic Preparations for Skin in the Prevention of Contamination of Percutaneously Drawn Blood Cultures: a Randomized Trial, J. Clin. Microbiol.; 40: 1660-1665
  2. Trautner B.W., Clarridge J.E., Darouiche R.O. (2002) Skin Antisepsis Kits containing Alcohol and Chlorhexidine Gluconate or Tincture of Iodine are Associated with Low Rates of Blood Culture Contamination, Infect Control Hosp Epidemiol;23:397-401 Blood culture sampling in adults November 2007 Pages 1-5
  3. EPIC 3 (2014): National Evidence- Based Guidelines for Preventing Healthcare-Associated Infections in NHS Hospitals in England. JOURNAL OF HOSPITAL INFECTION.

Approved By

Improving Antimicrobial Prescribing Group

Document history

LHP version 1.0

Related information

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