Blood cultures and antibiotic iv meds

emtb2rn, BSN, RN, EMT-B · Mar 10, 2011

Our protocol is iv abx within 4 hours of triage for pna. Our computer order set for pna abx actually states "do not administer until blood cultures are drawn". I've never heard of an issue with meds regularly being given before cultures.

We draw one set of cultures when the line goes in (it's pretty easy to tell who's gonna need cultures) and phlebotomy (or us) draws the 2nd set.

Are the same folks doing this over and over at your er? Localized problem or systemic?

BabyLady, BSN, RN · Mar 10, 2011

In the er where I work we are having issues with getting blood cultures drawn before antibiotics ae given on pneumonia patients. We have core measures that require antibiotics within six hours of being seen. We keep having antibiotic mess being given before blood culture draws. How do other ERs handle this?

The ER at my facility typically draws the blood culture when the IV is started to keep the patient from being stuck twice....it is the responsibility of the nurse starting the IV to draw the culture if it has not been yet or VERIFY if it has been drawn prior to AB administration.

Blood cultures require so little blood (ours only requires .5 ml) that even if they are not sure if one needs to be drawn, they still set it up in the cuture bottle just in case...very, very few of them are tossed.

Esme12, ASN, BSN, RN · Mar 10, 2011

The ED's I am famiiar with........ it is routine for the nurses to draw labs when the IV/saline lock is inserted and it is protocol that a patient with a temp and cough get blood cultures done x 1 (one areobic one anerobic). It is the nurses responsibility to ensure the cultures are drawn before antibiotics are begun and they are all initial dosed in the ED.

cview110 · Mar 10, 2011

It seems to be a symstemic problem. Lab frowns on getting blood cultures w/o orders. "too expensive and wasteful". Am going to meeting today to tweak protocols.

SMARN · Mar 10, 2011

Like others have said, in patient's who have any URI/CAP type sxs, the first BC is drawn when IV is started, and often times a lactic acid as well. 2nd set is then either drawn by the nurse; if LA wasn't drawn earlier, it's drawn with the 2nd set of BC. Our core measures call for 2 sets of BC and a LA drawn and abx given within 6hrs of presentation.

BabyLady, BSN, RN · Mar 10, 2011

It seems to be a symstemic problem. Lab frowns on getting blood cultures w/o orders. "too expensive and wasteful". Am going to meeting today to tweak protocols.

...just to clarify...we STILL need an order to send the culture to the lab and the lab will not run it unless there is an order, we just do not need an immediate order to draw it. From our understanding, the vials that contain the cultures are cheap.

Assuming there is a physician somewhere in the ER, getting an order is as simple as, "I just got a blood culture on Mr. Smith, you want me to write a verbal order to run it?"...Dr. Jones will either say yes or no...you write the verbal order and shoot it to the lab.

The only blood cultures that are run on protocol in our facility is transfers from another facility..and obviously we have to run those to cover our own butts.

neuroms · Mar 10, 2011

do you work with an electronic record or paper orders? Because, as emtb2rn pointed out, most hospitals now have automatic protocols dictating that the first abx dose not be administered until a culture is drawn.

SMARN · Mar 10, 2011

We have an electronic system (McKesson). Built into our system are order sets for CC we see very often (abdominal pain, URI, chest pain, SOB, etc). The sets have already been signed off on as "protocol" so as nurses we are able to put in orders prior to the MD seeing the patient. Fever, neg flu swab, cough, congestion, low sats, etc, all warrant a CAP workup. If it's questionable, and really call for a chest XR first, we have IV stopcocks that allow us to pull blood after the IV is in (you just have to waste first).

allstudentnurses, ASN, RN · Mar 10, 2011

You could start having laboratory put something on the patients wristband (like a green dot) indicating cultures have been drawn, giving you the "green light" to give the antibiotics, just a thought.

GM2RN · Mar 11, 2011

I agree that it is SOP to draw blood and cultures with IV starts, unless a pt is brought in by EMS and already has an IV.

Part of being an ED nurse is anticipating what the patient is going to need even before they see the doctor. Any adult patient that I get with an elevated temp, breathing problems, or I otherwise think they may be septic, and that I feel will also need a line, I always draw cultures. If the doc decides they don't need them, we just toss them, but most are used.

bonestAx · Mar 11, 2011

Well, I obviously work in the ER with you because we have been having the same problem. Doc's say no no I don't want cultures just start the abx. Then as soon as you start it there's the order in the computer ! They have also mentioned that they don't really like doing cultures on as many patients as we had been doing because it "wasn't necessary".

But, when you go to your pt that's SOB, has productive sputum, and diminished breath sounds and you go hmm must have pneumonia.. Go ahead and draw the cultures. Or just do them when you go to start the abx. whether they are ordered or not. It is in the best interest of the patient after all and that is what we are here for. You can always tell the doc that you drew them and they might just put the order in for them for you depending on your rapport with them.