why no tylenol before blood cultures drawn? - page 3

We were just discussing why last night and everyone had a different reason and most just heard not to.... Read More

  1. by   Spidey's mom
    Quote from KarafromPhilly
    I disagree. Not to be nitpicky as I see this topic has generated quite a few responses, but the clinical presentation has already, in a sense, presented itself. With the fever, we're aware that there is some kind of infection going on. If it's, say, a nosocomial pneumonia, other sx will present themselves in due time, and these other sx wouldn't be affected by the fact that the pt. took APAP for the temp. I understand that the elevated temp is the body's response to the infection, and it's not really necessary to stamp it out, but by the same token I don't see any reason for the patient to be really uncomfortable if they are having a serious spike in temp. Am I missing something?
    I agree with you . . . not sure why tylenol reducing fever has anything to do with what kind of "germs" we are dealing with. Tylenol doesn't kill the "germs" and they would still be in the sample whether we suppressed the fever or not.

    This is interesting . .. .still think it is an old wive's tale but we need some help from an expert.

    steph
  2. by   Jen2
    I used to work as a phlebotomist and the microbiologist in the lab explained to me that the bacteria in the blood is at it's highest when the temp spikes, therefore increasing the chance of capturing the bacteria. Blood cultures are usually drawn 1/2 hour apart or from two different sites because bacteria "bursts" in cycles and if you catch the bacteria at it's highest population (during fever spike) and during the "burst" cycle you get the most accurate result. Blood cultures come in two different sets, Resin and Nonresin. If a patient is on antibiotics you can still draw blood cultures using a nonresin bottle and get fairly accurate results. However the ideal is to draw two sets 1/2 hour apart or from two different sites during the spike of the fever. At least this is what I was taught.
  3. by   Morguein
    If we are to withold antibiotics before getting blood cultures, how long should we wait after witholding the antibiotics before getting the blood cultures? Usually our patients are on antibiotics around the clock (ex. q 8 hrs). I always thought that the reason why we're getting the cultures is to see if there are different bacteria that's growing that isn't being taken care of by the current regimine of antibiotics being given. I was never taught to withold the antibiotics before getting blood cultures.
  4. by   cannoli
    Quote from Moonepie
    If we are to withold antibiotics before getting blood cultures, how long should we wait after witholding the antibiotics before getting the blood cultures? Usually our patients are on antibiotics around the clock (ex. q 8 hrs). I always thought that the reason why we're getting the cultures is to see if there are different bacteria that's growing that isn't being taken care of by the current regimine of antibiotics being given. I was never taught to withold the antibiotics before getting blood cultures.
    I think they are referring to the initial dose of antibiotic.
  5. by   begalli
    Quote from Jen2
    I used to work as a phlebotomist and the microbiologist in the lab explained to me that the bacteria in the blood is at it's highest when the temp spikes, therefore increasing the chance of capturing the bacteria. Blood cultures are usually drawn 1/2 hour apart or from two different sites because bacteria "bursts" in cycles and if you catch the bacteria at it's highest population (during fever spike) and during the "burst" cycle you get the most accurate result. Blood cultures come in two different sets, Resin and Nonresin. If a patient is on antibiotics you can still draw blood cultures using a nonresin bottle and get fairly accurate results. However the ideal is to draw two sets 1/2 hour apart or from two different sites during the spike of the fever. At least this is what I was taught.
    And there in this quote is the answer.

    How did I miss this thread?!

    I worked in a large county hospital clinical lab for almost a decade before I became a nurse. They were very good at educating the phlebotomists for the rationales behind what they were doing and the importance of the specimen collection which I thought at the time that nurses took too lightly. I still do to an extent, but realize that this important aspect of patient care is completely missing in nursing school.

    I don't think it's so much that an antipyretic shouldn't be given before cultures are taken, but more that the cultures need to be drawn at the time of the fever spike. Like Jen2 says, bacteria enters (bursts) the blood 30-90 mintues before the fever spike. Collecting just after the spike is the best time to capture the microorganism because the numbers of the organism present and the chances of finding the organism are greatest at this time.

    Giving tylenol doesn't mean that burst doesn't happen, or that it alters the burst or number of organisms, it just means that you might not notice that it's happening and fail to collect the specimen at the proper time. This method of collection is most important for the very first set of cultures collected from a patient at the onset of illness.

    I think it's okay to give tylenol at a fever spike as long as the cultures are drawn in a timely manner.

    With conditions such as endocarditis or continuous sepsis however the timing isn't as important because the bacteria is always present in the blood.
    Last edit by begalli on Jan 1, '05
  6. by   Jen2
    I worked in a large county hospital lab for almost a decade before I became a nurse. They were very good at educating the phlebotomists for the rationales behind what they were doing and the importance of the specimen collection which I thought at the time that nurses took too lightly. I still do to an extent, but realize that this important aspect of patient care is completely missing in nursing school.
    Thank you for that comment. While I was working as a phleb all those years, quite a number of nurses would brush off the phlebotomist as UAP's that didn't know squat. My work as a phleb has helped me out a great deal in nursing school. There's a lot more to it than just sticking needles in peoples arms. I had so many nurses yell at me because I would refuse to draw a routine CBC on a patient that was being transfused. I once had a nurse call over and ask me to come and do stat blood cultures and when I asked her if the patient was on an antibiotic or not she snapped and said. "what do you need to know that for, just come and draw it" (not knowing that you use entirely different bottles if the patient is on an ATB). We don't get alot of rationale about bloodwork in nursing school. I guess that's why we have lab techs. Besides nurses have way too many other things on their minds then knowing which bloos test goes in which tube.
  7. by   VickyRN
    Quote from begalli
    And there in this quote is the answer.

    How did I miss this thread?!

    I worked in a large county hospital clinical lab for almost a decade before I became a nurse. They were very good at educating the phlebotomists for the rationales behind what they were doing and the importance of the specimen collection which I thought at the time that nurses took too lightly. I still do to an extent, but realize that this important aspect of patient care is completely missing in nursing school.

    I don't think it's so much that an antipyretic shouldn't be given before cultures are taken, but more that the cultures need to be drawn at the time of the fever spike. Like Jen2 says, bacteria enters (bursts) the blood 30-90 mintues before the fever spike. Collecting just after the spike is the best time to capture the microorganism because the numbers of the organism present and the chances of finding the organism are greatest at this time.

    Giving tylenol doesn't mean that burst doesn't happen, or that it alters the burst or number of organisms, it just means that you might not notice that it's happening and fail to collect the specimen at the proper time. This method of collection is most important for the very first set of cultures collected from a patient at the onset of illness.

    I think it's okay to give tylenol at a fever spike as long as the cultures are drawn in a timely manner.

    With conditions such as endocarditis or continuous sepsis however the timing isn't as important because the bacteria is always present in the blood.
    Excellent post. At one of our clinical sites (a very large teaching hospital), work redesign has resulted in nurses (and CNAII's with special training) being required to draw blood for labs, including blood cultures. Part of our training is knowing order of draw for tubes, difference between pediatric and adult tubes, how much minimal blood is required for an accurate lab readout, which ones to place on ice, etc. This is great information on blood cultures. RN's at this facility also routinely draw ABG's, but that's a whole different subject :uhoh21:
  8. by   Ronigrrl
    Yay!! I have worked in 2 Level I Trauma centers and here some people say the Tylenol Myth and others who think it's bogus. Personally I think it is Bogus. As long as you allow a fever to happen and culture after a defined parameter Tylenol should not interfere with culture results. I do understand the need to hold first dose antibiotics pending culture draws. This is why our Tylenol is usually written PRN T>38.5. At my old place of employment folks were lazy sometimes and gave tylenol all shift to avoid pan culturing a pt. I am waiting for my ID docs to round tomorrow am and will verify with them.
  9. by   nalu0622
    Honestly people... It has nothing to do with the CULTURING of the BLOOD.. It is is NOT an ANTIBIOTIC.. Going back to basic, ACETAMINOPHEN (TYLENOL) is a PAIN RELIEVER AND A FEVER REDUCER... If we look closer, it is not given to patient with kidney or liver disease or who are alcoholic.
    What are the possible complication or SERIOUS SIDE EFFECTS under this medication?
    Allergic reaction

    Liver Damage (yellowing of the skin or eyes, nausea, abdominal pain or discomfort, unusual bleeding or bruising, severe fatigue);

    Blood problems (easy or unusual bleeding or bruising)..

    Thus in conclusion, It has something to do with the PROCEDURE ITSELF..
    Drawing of Blood can lead to Blood related Problems.. I think it is much logical to say than to relate it with the CULTURE..
  10. by   nalu0622
    Quote from begalli
    And there in this quote is the answer.

    How did I miss this thread?!

    I worked in a large county hospital clinical lab for almost a decade before I became a nurse. They were very good at educating the phlebotomists for the rationales behind what they were doing and the importance of the specimen collection which I thought at the time that nurses took too lightly. I still do to an extent, but realize that this important aspect of patient care is completely missing in nursing school.

    I don't think it's so much that an antipyretic shouldn't be given before cultures are taken, but more that the cultures need to be drawn at the time of the fever spike. Like Jen2 says, bacteria enters (bursts) the blood 30-90 mintues before the fever spike. Collecting just after the spike is the best time to capture the microorganism because the numbers of the organism present and the chances of finding the organism are greatest at this time.

    Giving tylenol doesn't mean that burst doesn't happen, or that it alters the burst or number of organisms, it just means that you might not notice that it's happening and fail to collect the specimen at the proper time. This method of collection is most important for the very first set of cultures collected from a patient at the onset of illness.

    I think it's okay to give tylenol at a fever spike as long as the cultures are drawn in a timely manner.

    With conditions such as endocarditis or continuous sepsis however the timing isn't as important because the bacteria is always present in the blood.
    This is what i love about allnurses.. You learn from others... great!!!
  11. by   annmariern
    Interesting post, learned something new re the spike in temp after the bursts of bacteria, while we are on the subject a pet peeve of mine. What is is with nurses giving tylenol at the slightest fever? I mean, asymptomatic pt, 99.8 give tylenol. Isn't it a defense response, basic and useful especially in getting a true picture of whats going on clinically? Why surpress it? Yes, its easier than calling docs, and getting a ton of new orders, but when the pt eventually goes septic, much worse. I took care of a pt once who had regulary temps of 105 degrees; apart from being a lovely shade of red, he felt fine, multiple cultures of everything, nothing. Turned out to be a weird reaction to IV Flagyl.
  12. by   annmariern
    Quote from nalu0622
    Honestly people... It has nothing to do with the CULTURING of the BLOOD.. It is is NOT an ANTIBIOTIC.. Going back to basic, ACETAMINOPHEN (TYLENOL) is a PAIN RELIEVER AND A FEVER REDUCER... If we look closer, it is not given to patient with kidney or liver disease or who are alcoholic.
    What are the possible complication or SERIOUS SIDE EFFECTS under this medication?
    Allergic reaction

    Liver Damage (yellowing of the skin or eyes, nausea, abdominal pain or discomfort, unusual bleeding or bruising, severe fatigue);

    Blood problems (easy or unusual bleeding or bruising)..

    Thus in conclusion, It has something to do with the PROCEDURE ITSELF..
    Drawing of Blood can lead to Blood related Problems.. I think it is much logical to say than to relate it with the CULTURE..

    OK; I would guess most of us reading this know what tylenol is for, what the side effects are, what liver damage involves, thanks for the refreshers; But seems from prior posts, it does affect when the culture is drawn, how promptly sepsis is identified and treated. Therefore it does matter.
  13. by   Ronigrrl
    Thanks Annmarie! My intelligence was a bit offended there too, lol. As far as the renal impairment mentioned, Tylenol has no effect on that unless it is hepatorenal. Ibuprofen is what you need to avoid in the setting of CRI/CRF/ARF.

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