PROCEDURE FOR DRAWING BLOOD CULTURES IN CCTC
Obtain an Order Identify Number of Samples to be Collected Order Blood Cultures in Power Chart Entering Specimen Type Entering Specimen Description		Entering Label Comments Request Catheter Associated Bacteremia Evaluation Collect Samples Label Specimens Document View Results and Ordering Information
PROCEDURE		RATIONALE FOR PROCEDURE
1.	Obtain an Order Verify order is written (cultures are not included in any preprinted orders or protocols). Review need for cultures at time of all admission blood work.	1.	A medical order or supportive protocol is required by the College of Nurses. Many patients are admitted with sepsis as a differential diagnosis; prompt cultures are indicated.
2.	Identify Number of Samples to be Collected See Blood Culture Ordering Decision Tree: 1. If the patient has no intravascular lines or newly established lines, draw 2 sets of perpheral cultures. Blood cultures drawn at the time of line insertion can be considered peripheral. Once the line has been previously accessed for blood samples, it cannot be considered a peripheral sample. If a patient is hypotensive or in shock, do not delay blood culture sampling while awaiting line placement. Obtain two peripheral cultures and start antibiotics right away. If blood cultures cannot be obtained quickly in a patient in shock, do not delay administration of antibiotics. 2. If the patient has intravascular lines in place that are > 24-48 hours, draw cultures and request a "CAB" assessment as follows: Collect one set of blood cultures from a Peripheral Stab PLUS from EACH indwelling line (arterial, central, PICC). Each set of blood cultures consists of one anaerobic and one aerobic bottle. Cultures from all sites should be drawn within 15 minutes. Dialysis lines should also be cultured, however, cultures must be drawn by a nurse approved for CRRT or hemodialysis. Consult the PCVC team or oncology team to access tunneled catheters. For multilumen central venous catheters, obtain blood culture from distal lumen whenever possible. If a patient has a long term multilumen catheter (e.g., implanted central venous lines for oncology patients), check with physician re the need to culture each lumen. NOTE: A CAB assessment will only be performed if a peripheral sample is included. A newly established line can be considered a "peripheral stab" ONLY if it is newly established and has not been previously used for blood drawing. If the sample is drawn at the time of insertion, identify this as a "peripheral culture" in the lab orders. If a peripheral culture cannot be obtained, report this under "Comments" in Power Chart (see item 7) and document in the AI flow sheet. (A CAB assessment will not be performed). 3. If the patient has a previously established line that is being removed, obtain cultures from all indwelling lines PLUS a peripheral culture and send the tip of the removed catheter for culture. A CAB assessment is not ordered unless there is concern that one of the remaining lines may be the source for infection.	2.	Simultaneous results from multiple sites aids in the interpretation of the results (e.g., differentiate contamination, colonization and clinical infection). Each indwelling line has the potential to become colonized or the source of a blood stream infection. Colonization is more likely to occur at the distal lumen, but could be isolated or more significant in an isolated lumen.
3.	Order Blood Cultures in Power Chart Log onto Power Chart using your own user ID. Choose "Blood Culture" from "Laboratory" Gram stains and STAT cultures cannot be ordered. Adjust the ordering time for each blood culture sample (e.g., peripheral, arterial, central) to ensure they are at least one minute apart. Always log out of Power Chart when done.	2.	Blood cultures require a minimum period of time for growth. Power Chart will not allow 2 identical lab tests to be ordered with the same time.
4.	Enter Specimen Type Under sample type choose "Venipuncture Blood ", "Arterial Line Blood " or "Central Line Blood " Choose "Central Line Blood for PICC" or Dialysis.	4.	To identify type of sample.

5.	Enter Specimen Description Choose "Specimen Description". In the right hand box, type in the following: Site location (e.g., L femoral) Lumen used if multilumen catheter (e.g., distal lumen) Date catheter inserted Identify as "newly inserted" only if first sample drawn.Samples drawn at the time of line insertion may be labelled as peripheral.	5.	Interpretation of results and treatment decisions depends upon a clear understanding of the sample.

6.	Entering Label Comments Select label comments. In the right hand box, type the site location. Information typed into this box will appear on the label to help ensure that the correct label is applied to each specimen.	6.

7.	Request Catheter Associated Bacteremia Assessment If the patient has indwelling lines and the lines are not being immediately removed: Click on the " Order Comments Folder". Type in "CAB". A peripheral sample must be collected within 15 minutes of the line sample. A new arterial line can be used to obtain the peripheral culture if this is the first time the line is accessed. This sample should be identified as a "peripheral" culture. The lab will not perform a CAB assessment unless a peripheral sample is collected. Efforts should be made to obtain a peripheral with each set of cultures. If the indwelling line is being removed, send peripheral and line cultures as above, but DO NOT request CAB assessment. Send the tip of the line for culture.	7.	CAB (Catheter Associated Bacteremia) assessment provides a "time to positivity result". If an indwelling line becomes positive by > 2 hours earlier than the peripheral sample, it suggests increased colonization of the catheter. If both the peripheral and line cultures become positive within 2 hours, it suggests bacteremia. Click to view Catheter Associated Bacteremia algorhithm (only available from within LHSC). CAB assessment is not needed if the catheter is being removed. A tip culture provides a quantitative evaluation of organisms. A colony count > 15 plus a positive blood culture is indicative of Catheter Associated Bactereia.

8.	Collect Specimens Perform hand hygiene and don non-sterile gloves. Use 2 - chlorhexidine 2% with 70% alcohol swabs to cleans the sampling port. Scrub vigorously in a horizontal direction using the first swab. Scrub vigorously in a vertical direction with the second swab. Allow the prep to dry FOR ONE FULL MINUTE before sampling. Ensure that air does not enter the anaerobic bottle during collection. Remove non-sterile gloves and perform hand hygiene. Send samples down to lab in a biohazardous bag.	8.	The back and forth scrubbing loosens bacteria and provides more effective disinfection of the site. The prep must dry to activate the antimicrobial properties. The Centre for Disease Control (CDC) recommends cleaning injection sites with 70% alcohol or iodophors. Chlorhexidine is recommended for skin preps and has not been studied for injection sites. Use of a product that includes alcohol is recommended.
9.	Label Specimens Place labels on specimens. Select one of the small square barcodes and place on each bottle. Verify that the label name and patient are correct. Verify that the label matches the correct sample (e.g., arterial samples and arterial labels). Sign sample requisition and record time sample was drawn.	9.	Samples will be discarded by lab if unsigned.
10.	Document List samples collected on the nursing graphic record. Ensure an order has been written to obtain blood sample.	10.	Medical orders are required for blood sampling. Blood cultures are not included in routine orders.
11.	View Ordering Information Select the desired blood culture order from the from the Power Chart Flowsheet, Orders List or Task List. Right click and select "Orders Information". All of the information entered when the test was ordered is revealed. The name of the nurse who ordered the test is also displayed.	11.	Ordering information is available to aid in the interpretation of results.

Always log off, by exiting the patient's chart.