Blood cultures

jadelpn, LPN, EMT-B · Sep 18, 2013

I would have this discussion with the head of your lab department. They are usually the ones who set a policy and procedure on how they want nurses to draw them.They also have policies on the order they want labs drawn in, cultures included. Sometimes there's alternate skin prep that is needed. They are the ones who have to set them up when complete, so the lab manager can give you the information you need.

Also the MD's on what they usually look for--ie: x2--2 sites, 2 tubes each site, or 1 site 2 tubes, some do not want you to draw a set off an IV start--

So I would start with the lab manager, what their policy is, and do an educational blurb on the procedure.

green34 · Sep 18, 2013

Well, I don't have a written policy but I can probably find one for you when I go back to work. The ER has stricter rules due to high number of contaminated cultures we've had recently.

Basically, we prep the bottles with alcohol preps for 30 seconds. Then we find a site and prep it for 1 full minute with chloraprep sponges and not the little chloraprep things that come in the IV prep kits. It has to be the big sponges.

Then we have to get 10 cc per bottle. Meaning we have to either track down a 20 cc syringe or use a butterfly needle to swap out the 10 cc syringes. I personally swap out the syringes as it is easier for me to draw back on a 10 cc than a 20 cc. Plus I can tape down the butterfly as to not shake or drop it as my hands can become stiff sometimes. If we get less than 10 cc per bottle, we have to put 8 in the anaerobic bottle and the rest in the aerobic bottle.

We have to do it from 2 different sites. Babies only get 1 bottle and that is the anaerobic bottle.

We can draw from IV sites that have been prepped with big chlora preps.

All blood cultures need to be drawn before antibiotics.

We used to just do half of a 10cc syringe per bottle, but supposedly JCAHO wants 10 ml per bottle. That's what the rumor is anyway. Back when we could split it to smaller numbers (our blood culture bottles say 0.5 ml - 10 ml for the amount to put in), we used to have to do blood cultures first, blue, green, and purple but green always hemolyzed. Now with 10 ml per bottle, we don't have that issue since we'd have to draw 30 ml - 35 ml for all of the blood work (depending on the rare yellow tube)