Specimen Requirements

Optimal times for specimen collection must be based upon both the type of infectious disease process and ability of laboratory to expertly process specimens. The Microbiology Laboratory is not as well staffed during evening and late night hours. Specimens collected late in the evening often do not produce adequate growth by next morning. STAT testing is available at all times for critical tests including blood cultures, body fluid Gram stains, etc.

Specimen must arrive within 2 hours of draw.

1. Specimen placed directly into blood culture bottle(s). One regular “set” of  adult blood culture (BD BACTEC^TM bottles) consists of an aerobic bottle and an anaerobic bottle. One pediatric “set” consists of a single BD BACTEC^TM Peds Plus bottle (aero/ana/resin).

2. Blood cultures should be drawn in duplicate, from 2 different sites, to reduce the chance of skin surface antimicrobial germ contamination in both sets of bottles at a single draw. For example, if requisition states “Blood Cultures x 2, from different sites, 15 minutes apart,”  venipuncturist should be prepared to draw first blood culture, wait 15 minutes, and then draw second blood culture from a different vein. Under no circumstances should 2 sets of blood cultures be drawn from the same venipuncture or more than 3 sets drawn within a 24 hour period.

Materials

1. Well stocked venipuncture tray
2. Appropriate blood culture bottles
3. ChloraPrep^® SEPP^® Applicator

4. Gloves

Procedure

1. Following instructions for a routine venipuncture, identify patient.

2. Prepare materials - blood culture bottles, tourniquet, ChloraPrep^® SEPP^® Applicator, VACUTAINER® holder, butterfly needle, etc.

3. Put on disposable gloves. Mark recommended fill line on scale on label of bottle according to kind of bottle being used.

4. Prepare 1 aerobic (blue-top) and 1 anaerobic (yellow-top) vial for each regular blood culture order. Remove plastic flip cap from vial, and clean the exposed rubber septum with ChloraPrep^® SEPP^® Applicator.

5. Apply tourniquet 3 inches above the vein to be used. Palpate the vein now. After vein has been prepped, you may not touch it again.

6. Tear open ChloraPrep^® SEPP^® Applicator packet and remove applicator.  Crush ampule and apply applicator to the procedure site by holding applicator between thumb and index finger using repeated back-and-forth strokes for 15 seconds. Allow the prepped area to dry for 30 seconds. Do not blot or wipe dry.

7. Proceed with venipuncture maintaining a sterile draw site. Draw blood into bottle to marked fill line (minimum volume:  3 mL).

8. If recommended volume of blood cannot be expected to be obtained, use pediatric resin bottle (pink BACTEC^TM Peds Plus). These bottles are to be used when only small amounts of blood can be drawn. This resin bottle is formulated to get maximum growth with as little as 0.5 mL whole blood. Pediatric and newborn draw volumes are generally 1 mL to 3 mL of whole blood.

9. Label bottles carefully, ie, #1-right arm; #2-left arm. Peel labels from requisitions, and apply to bottles. Do not obscure barcode label on the side of blood bottles. Mark date and time of draw, site, and venipuncturist initials on label of bottles and on demographic label.

10. If additional tests have been ordered, draw blood culture specimen first.

11. Clean and bandage patient when puncture site has stopped bleeding.

12. After 15 minutes (if so ordered), proceed with venipuncture using a different site.

13. Maintain sterility and forward promptly.

Note:  1. Specimen source and site are required on request form for processing.

2. Growth of contaminants may occur when draw site is not disinfected properly.

3. Increased storage times can compromise culture results. If culture is requested on a specimen that exceeds transport/storage requirements, it will be noted in the report.