Collection Instructions

Specimen Type: Whole blood or bone marrow
Container(s): BACTEC MycoF Vial (preferred) or Green top (Sodium Heparin) or Green top (Lithium Heparin)

Preferred Volume to Collect: 5 mL

Minimum Volume to Collect: 3 mL

• Notify Microbiology in suspected cases of:
  • Brucella
  • Mycobacterial (AFB)
  • Histoplasma or other fungal or unusual organism is suspected.

• Recommendations for detection of infection:

  • Acute sepsis: Collect 2 to 3 sets of blood cultures from separately prepared sites prior to starting antibiotic therapy.
  • Acute endocarditis: Collect 3 sets of blood cultures with three separate venipunctures over 1 to 2 hours, prior to starting antibiotic therapy.
  • Sub-acute bacterial endocarditis: Collect 3 sets of blood cultures in 24 hours. If all are negative after 24 hours, obtain physician order for 3 additional sets
• Newly admitted HEME/ONC from ED/Clinic:
  • Draw at least 3 mL off of each line and place blood in aerobic FAN plus blood culture bottle
  • If there is mucositis or abdominal concerns present, draw an extra 3 mL from each line and the peripheral vein and put into an anaerobic blood culture bottle 
• Already hospitalized HEME/ONC inpatient 
  • Draw 1-3 mL off each line and put into an aerobic FAN bottle
  • If there is mucositis or abdominal concerns present, draw 3 mL off each line and put into an anaerobic bottle.
  • If this is the first temperature spike, blood should be drawn from a peripheral vein and placed into an aerobic FAN bottle and into an anaerobic bottle if there is mucositis present
  • Unless otherwise ordered, peripheral cultures are not necessary for subsequent fever spike.
  • If a fungal infection is suspected, test must be ordered, and 1-5 mL of blood should be drawn in the BD BACTEC Myco/F Lytic bottle
• Bone Marrow Transplant (BMT) Patients:
  • Draw at least 6 mL off each line and put half in an aerobic bottle and half into an anaerobic bottle
  • Do not draw peripheral cultures unless ordered
  • If a fungal infection is suspected, test must be ordered and 1-5 mL of blood should be drawn in the BD BACTEC Myco/F Lytic bottle.
• Adult Line-related sepsis:
  • Draw one set via the line in addition to the routine blood drawn peripherally.
• If a provider suspects an anaerobic infection (intra-abdominal infections, severe immunocompromised status, etc), requests may be made that the specimen be split between aerobic and anaerobic bottles.

• Disinfect the blood culture bottle(s) and/or the blood culture collection tubes using CHG swab stick or alcohol prep pad (one swab stick can be used for all bottles/tubes). Remove the plastic seal from the bottle and saturate the rubber septum with the antiseptic. Allow to air dry.
• Position and prepare the patient.
• Prepare the patient’s venipuncture site by opening the
  • CHG One-Step Frepp applicator
    • Hold the applicator in a downward position.
    • Do not touch the sponge.
    • Pinch once to break the ampule. You should hear a pop.
    • Saturate the sponge with CHG by gently pressing it against the treatment area.
    • Vigorously scrub back and forth the treatment area for 30 seconds.
  • CHG Triple Swab sticks
    • Open packet and use one swab stick to prep bottle by saturating the bottle/tube top.
    • Use a second swab stick to prep the patient’s arm by vigorously scrubbing back and forth for 30 seconds.
    • The third swab stick can be used to prep the patient if a second set of cultures has been ordered
  • Pennock: Prevantics Swabstick or Chloraprep Single Swabstick
    • Open packet and place on flat side of foam tip to skin site and vigorously scrub back and forth for 30 seconds to 1 minute.
    • Allow to air dry for at least 90 seconds.
  • Pediatrics less than 40 weeks gestation and/or allergic to chlorhexidine: Betadine wipes.
    • Cleanse the site using a back and forth motion, utilizing friction to aid in disinfection, for at least 30 seconds. Allow to air dry completely for at least 90 seconds or as long as necessary.
• Allow to air dry (do not blow on or wave at site)
• Apply the tourniquet 3 to 4 inches above the puncture site for no longer than 1 minute. The use of a tourniquet is not always appropriate in drawing children.

• Perform venipuncture – following order of draw
  • Draw blood:
    • Male transfer device: Winged Infusion System attached to a Male Blood Culture Transfer device, allow a fill of up to 10 mL per bottle.
    • Female transfer device: Collect blood in a syringe(s) and then attached to a female transfer device.
  • Order of Draw:
    • Aerobic
      • Green
    • Anaerobic:
      • Orange
    • Any additional labs
  • Bottles will not stop filling at 10mL, use caution to avoid overfilling.
    • Adult patients:

      • Optimal 10 mL per bottle; minimum of 5mL in an aerobic (green) bottle.

      • When less than the recommended volume of blood is collected for culture, the aerobic bottle should be filled with 10 mL of blood if available. Any remaining blood should then be placed in the anaerobic bottle

      • If less than or equal to 9.9 mL is drawn place all into the aerobic bottle.

    • Pediatric patients

      • Based on weight -- see Pediatric Blood Culture Volumes document

    • Peds HEM/ONC: Collect no more than 3 mL in an aerobic bottle regardless of patient age. Minimum is 1 mL.
    • Premature infants weighing less than 1500 grams consult physician to determine volume.
• Release and remove tourniquet per policy.
• Place clean sterile gauze over the puncture site and apply direct pressure. (Cotton balls are not recommended)
• Gently invert bottles 8-10 times to prevent clotting.
• Label the bottles at the bed-side (or with patient): patient information, date and time collected, source is required information. For line related sepsis draws, indicate by writing on the patient's label source of the line. Record volume in each bottle on the outside
  • Link: Important Labeling Instructions
• Bandage the patient’s venipuncture site.
• Log specimens into system as collected. Note: When using an electronic scanning device, you must scan the first labeled set before collecting the second set of blood cultures, to assure an accurate time stamp on collection and consequently, the delivery of timely antibiotics.

Note: Clearing a line before obtaining a sample will not eliminate all the bacteria within that line; therefore, a physician’s order should be obtained to draw one set of blood cultures peripherally to help determine if the infection is true bacteremia versus a line contamination.