Educate me on Blood Cultures

BrnEyedGirl, BSN, MSN, RN, APRN · Dec 13, 2010

I guess it depends on the pt and why the doc ordered the cultures. I work ER and I'm not seeing as many orders for BC X2 as I did in years past. I worked in lab many years ago (almost 25 yrs) and at that time we always wanted two cultures from two different sites to verify results. Blood cultures are very often contaminated due to not cleaning the site well or not cleaning the bottle well. If I have trouble getting cultures in the ER I call and let lab do it and save my IV.

Amnesiac70 · Dec 13, 2010

Ok. I have just discovered the search function and found some good posts re: the WHY of cultures. But the question remains, when should I be standing up to the white coats and saying "I can't get the second set of cultures, she's been poked multiple multiple times, can I just start the ABx anyways"?

Thank you

sunnycalifRN · Dec 13, 2010

Ok. I have just discovered the search function and found some good posts re: the WHY of cultures. But the question remains, when should I be standing up to the white coats and saying "I can't get the second set of cultures, she's been poked multiple multiple times, can I just start the ABx anyways"?
Thank you

on any really difficult stick, after you've given it your best effort, either call your unit "expert", if they're working that day, or ask the doc to get it, if they really, really need it.

BTW, you can usually get the median cubital vein on almost anyone

Fribblet · Dec 13, 2010

Art. stick.

Bam. Done. Easy.

Or, EJ.

No reason to stick a patient 600 times when they've got two big fatty veins just waiting to be accessed.

Unless, of course, they've used those up, too. Those patients are few and far between though.

Editorial Team / Moderator · Dec 13, 2010

We had a pt. recently with such bad anasarca that we couldn't even get an art stick. He's nearly 100 years old, so I'd say he's about used up his vessels. LOL

Larry77, RN · Dec 13, 2010

Have the doc get a femoral stick for the second set if you can't get it...that's what we do...

Our lab is pretty good though, pretty sure they can get blood from a turnip.

mmutk, BSN, RN, EMT-I · Dec 13, 2010

You must get at least one set before the antibiotics are on board. The second set would be nice too, they are not as helpful if there is already antibiotics in the bloodstream.

Can't get a vein? Stick em arterially. This is very important for determining the bug to treat so we aren't using broad spectrum antibiotics on everyone.

Emergency RN · Dec 13, 2010

We had a pt. recently with such bad anasarca that we couldn't even get an art stick. He's nearly 100 years old, so I'd say he's about used up his vessels. LOL

Even with extreme generalized edema (anasarca) one can still prevail with vascular access by utilizing the "pitting" property of that edema. Using transcutaneous illumination (eg. something like the venoscope, but a flashlight works just as well), first highlight a decent looking vein, then using your finger, apply steady pressure over the site until a deep pit forms, all the way down to the vein. By using this method, one can transiently displace the edema fluid from around the site. The temporarily displaced fluid generally takes anywhere from one to several minutes to return the area back to the edema state. That's more than plenty of time for an experienced clinician to successfully cannulate a vessel.

Note: I personally don't use the venoscope but linked to them to allow other readers to understand the concept of transcutaneous illumination. I find their product to be excessively expensive and actually difficult to use, when compared to my little LED flashlight. The only necessity is that the flashlight must have an opaque rim, and you should subdue the ambient light in the room for best results.

Amnesiac70 · Dec 14, 2010

So the second set of BCL is important enough to be accessing EJ's for them then? Or art sticks? They are that important?

DC Collins, ASN · Dec 14, 2010

Yeah, a cpl of tries, then to the local expert, then the lab. Then, if the doc is adamant, the Doc can do what he/she wants or just order the Abx.

DC ED NOC RN ADN

Abbreviations R Us :)

Emergency RN · Dec 14, 2010

So the second set of BCL is important enough to be accessing EJ's for them then? Or art sticks? They are that important?

I think it important that we don't lose sight of the overall objectives here; namely the clinical betterment of the patient. Blood cultures are but one facet of the diagnostics that clinicians use to determine what is wrong. Of course, having that second set of cultures (as back up to validate the results of the first) is optimal. However, with fast moving sepsis, the principle goal is always to treat the patient as soon as possible, and not blindly focus on the task of drawing cultures to the point that it comes at the risk of detriment to the patient. There are occasions when the first dose of antibiotic given in a timely fashion can be life saving.

That is, there comes a point when one needs to put aside the cultures in the best interests of the patient. Just annotate your chart as to the reason why a second set wasn't obtainable, notify the MD, and then give the antibiotic as ordered.

We're nurses, not magicians. If blood cannot be obtained for a second set after several tries, then it is no longer a nursing responsibility. Call the MD.

As an aside, some here have advocated using arterial draws and external jugular venipuncture; I would caution that nurses who have never done this before to first determine what your institutional policy is regarding nurses and such routes of access, and if allowed, to be first trained in how to do so. Some hospital policies specifically prohibits such acts by their nurses. It isn't like starting a peripheral IV and one certainly should not poke around a patient's neck or arteries without knowing exactly what one was doing.