OBTAINING A CSF SAMPLE FROM AN INTRAVENTRICULAR CATHETER IN CCTC Obtain Equpment Prepare to Obtain Sample Obtain Sample Transfer Sample Restore Circuit Label Sample Document PROCEDURE RATIONALE FOR PROCEDURE 1. Obtain Equipment Face mask with shield Sterile gloves Sterile towel Chlorhexidine 2% with 70% alcohol swabs 3 ml syringe with needleless cannula Sterile specimen container (with orange lid) 1. Samples should be represent a freshly collection. Bacterial counts may multiply within drainage bag collections and provide inaccurate culture results. 2. Prepare to Obtain Sample Perform hand hygiene. Apply mask, don sterile gloves. Identify sampling port (port closest to patient catheter). Turn 3-way stopcock off to pressure tubing (pronged side of stopcock toward the pressure transducer). Close slide clamp distal to sampling port Open sterile towel on bed and position sampling port on top of towel. Scrub port vigorously with chlorhexidine/alcohol swab. Allow cleaning solution to dry for 1 minute. 2. Aseptic technique should be maintained. CSF contains glucose, supporting bacterial growth. With a 3-way stopcock, flat sides represent open pathways . The pronged side of the stopcock is off. To draw a sample of CSF, the circuit must be open between the catheter and sampling port. Cleaning solution must dry on surface to maximize antimicrobial properties. 3. Obtain Sample Slowly aspirate 2-3 ml of fluid into syringe over 1-2 minutes. Do not force or generate excessive vacuum. 3. Slow aspiration will allow gentle removal of sample without generating excessively negative pressures. 4. Transfer Sample Empty contents of syringe into sterile collection chamber. Tightly seal lid. 4. The lab will not accept specimens in syringes due to risk for spillage/exposure of body fluids. 5. Restore Circuit Open slide clamps. Return stopcock to presampling position as per written physician orders. Check all stopcocks and connections. Reconfirm level. Remove non-sterile gloves and perform hand hygiene, remove faskmask and shield. 5. To ensure ICP drainage system is returned to therapeutic position. 6. Label Specimens NOTE: ALL CSF CULTURE SAMPLES SHOULD BE ORDERED "STAT" AND A GRAM STAIN REQUESTED Place labels on specimens. Verify that the label name and patient are correct. Sign sample requisition and record time sample was drawn. Place sample in plastic biohazardous bag with label in outside pocket. Remove non-sterile gloves and perform hand hygiene. 6. Samples will be discarded by lab if unsigned. 7. Document List sample collected on the lab collection section of nursing flow sheet. Document on Kardex. 7. Kardex communicates to subsequent shifts to monitor for culture results. Developed by: Brenda Morgan CNS, CCTC August 17, 2006 Last Update:March 24, 2010.