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Thursday, November 18, 2021

Blood Culture Collection, Procedure, and Assessment by Nurses Note

 Blood Culture Collection, Procedure, and Assessment

Blood Culture Collection, Procedure, and Assessment by Nurses Note: Blood cultures are performed to detect bacterial invasion (bacteremia) and the systemic spread of such an infection (septicemia) through the bloodstream. In this procedure, a venous blood sample is collected by venipuncture into two bottles (one set), one containing an anaerobic medium and the other anaerobic medium. The bottles are incubated, encouraging any organisms that are present in the sample to grow in the media. Ideally, two to three sets of cultures, 1 hour apart or from separate sites, should be obtained

The main problem encountered with blood-culture testing is that the specimen is easily contaminated with bacteria from the environment. Care must be taken to clean the skin at the venipuncture site properly to prevent contamination with skin flora, and an aseptic technique must be used during the procedure. In addition, the access ports on the blood culture bottles must be properly cleaned before access.

Equipment for Blood Culture Collection and Procedure 

1. Tourniquet

2. Nonsterile gloves

3. Additional PPE, as indicated

4. Antimicrobial swabs, such as chlorhexidine, per facility policy, for cleaning the skin and culture bottle tops.

5. Vacutainer needle adaptor

6.  Sterile butterfly needle, gauge appropriate to the vein and sampling needs, using the smallest possible, with extension tubing.

7. Two blood-culture collection bottles for each set being obtained; one anaerobic bottle and one aerobic bottle.

8. Appropriate label for specimen, based on facility policy and procedure.

9. Biohazard bag.

10. Nonsterile 2 ✖ 2 gauze pads.

11. Sterile 2 ✖ 2 gauze pads.

13. Adhesive bandage.

Oligohydramnios: Treatment, Complications, Causes, Symptoms 

Assessment Guidelines for Blood Culture Collection and Procedure

1. Review the patient’s medical record and the medical record for the number and type of blood cultures to be obtained. Ensure that the appropriate computer laboratory request has been completed.

 2. Assess the patient for signs and symptoms of infection, including vital signs, and note any antibiotic therapy being administered. Inspect any invasive monitoring insertion sites or incisions for indications of infection.

 3. Assess the patient for any allergies, especially related to the topical antimicrobial used for skin cleansing. Assess for the presence of any conditions or use of medications that may prolong bleeding time, necessitating the additional application of pressure to the puncture site. Ask the patient about any previous laboratory testing that he or she may have had, including any problems, such as difficulty with venipuncture, fainting, or complaints of dizziness, lightheadedness, or nausea.

4. Assess the patient’s anxiety level and understanding of the reasons for the blood test. Assess the patency of the veins in both upper limbs. Palpate the veins to assess the condition of the vessel; the vein should be straight, feel soft, be cylindrical, and bounce when lightly pressed. Appropriate vessels will compress without rolling and have rapid rebound filling after compression. Avoid veins that are tender, sclerosed, thrombosed, fibrosed, or hard.

Nursing Diagnosis for Blood Culture Collection and Procedure

1. Deficient Knowledge.

2. Anxiety.

3. Risk for Infection.


Expected outcomes may include:

1. An uncontaminated specimen will be obtained and sent to the laboratory promptly.

2. The patient does not experience undue anxiety, injury, or infection.

3. The patient verbalizes an understanding of the reason for the test

Nursing Procedure for Blood Culture Collection 

 ACTION1: Gather the necessary supplies. Check product expiration dates. Identify an ordered number of blood culture sets and select the appropriate blood-collection bottles (at least one anaerobic and one aerobic bottle). If tests are ordered in addition to the blood cultures, collect the blood-culture specimens before other specimens.

     RATIONAL1: Organization facilitates the efficient performance of the procedure. Ensure proper functioning of equipment. Using correct bottles ensures accurate blood sampling.

ACTION2: Bring necessary equipment to the bedside stand or over bed table. 

     RATIONAL2: Bringing everything to the bedside conserves time and energy. Arranging items nearby is convenient, saves time, and avoids unnecessary stretching and twisting of muscles on the part of the nurse. The organization facilitates the performance of tasks.

ACTION3: Perform hand hygiene and put on PPE, if indicated.

     RATIONAL3: Hand hygiene and PPE prevent the transmission of microorganisms. PPE is required based on transmission precautions.

ACTION4: Identify the patient. Explain the procedure. Allow the patient time to ask questions and verbalize concerns about the venipuncture procedure.

     RATIONAL4: Identifying the patient ensures the right patient receives the intervention and helps prevent errors. Explanation provides reassurance and promotes cooperation.

ACTION5: Close curtains around bed and close the door to the room, if possible.

     RATIONAL5: Closing the door or curtain provides for patient privacy.


ACTION6: Check specimen label with patient identification bracelet. The label should include the patient’s name and identification number, time the specimen was collected, route of collection, identification of the person obtaining the sample, and any other information required by agency policy.

     RATIONAL6: Confirmation of patient identification information ensures the specimen is labeled correctly for the right patient.

ACTION7: Provide for good light. Artificial light is recommended. Place a trash receptacle within easy reach.

     RATIONAL7: Good lighting is necessary to perform the procedure properly. Having the trash receptacle in easy reach allows for safe disposal of contaminated materials.

ACTION8: Assist the patient to a comfortable position, either sitting or lying. If the patient is lying in bed, raise the bed to a comfortable working height, usually elbow height of the caregiver.

     RATIONAL8: Proper positioning allows easy access to the site and promotes patient comfort and safety. Proper bed height helps reduce back strain while performing the procedure.

ACTION9: Determine the patient’s preferred site for the procedure based on his or her previous experience. Expose the arm, supporting it in an extended position on a firm surface, such as a tabletop. Position self on the same side of the patient as the site selected. Apply a tourniquet to the upper arm on the chosen side approximately 3 to 4 inches above the potential puncture site. Apply sufficient pressure to impede venous circulation but not arterial blood flow.

     RATIONAL9: Patient preference promotes patient participation in treatment and gives the nurse information that may aid in site selection. Positioning close to the chosen site reduces back strain. Use of a tourniquet increases venous pressure to aid in vein identification. The tourniquet should remain in place no more than 90 seconds to prevent injury.

ACTION10: Put on nonsterile gloves. Assess the veins using inspection and palpation to determine the best puncture site. Refer to the Assessment information above.

     RATIONAL10: Gloves reduce the transmission of microorganisms. Using the best site reduces the risk of injury to the patient. Observation and palpation allow for making distinctions between other structures, such as tendons and arteries, in area to avoid injury.

ACTION11: Release the tourniquet. Check that the vein has decompressed.

     RATIONAL11: Releasing the tourniquet reduces the length of time the tourniquet is applied. The tourniquet should remain in place no more than 60 seconds to prevent injury, stasis, and hemoconcentration, which may alter results. Thrombosed veins will remain firm and palpable and should not be used for venipuncture.

ACTION12: Attach the butterfly-needle extension tubing to the Vacutainer device.

     RATIONAL12: Connection prepares device for use.

ACTION13: Move collection bottles to a location close to arm, with bottles sitting upright on tabletop.

     RATIONAL13: Bottles must be close enough to reach with extension tubing on the butterfly needle to fill after venipuncture is completed. Bottles should remain upright to prevent backflow of contents to the patient.

ACTION14: Clean the patient’s skin at the selected puncture site with the antimicrobial swab, according to facility policy. If using chlorhexidine, use a back-and-forth motion, applying friction for 30 seconds to the site, or use the procedure recommended by the manufacturer. Allow the site to dry

     RATIONAL: Cleaning the patient’s skin reduces the risk for the transmission of microorganisms. Allowing the skin to dry maximizes. antimicrobial action and prevents contact of the substance with the needle on insertion, thereby reducing the sting associated with insertion.

ACTION15: Using a new antimicrobial swab, clean the stoppers of the culture bottles with the appropriate antimicrobial, per facility policy. Cover bottle top with sterile gauze square, based on facility policy.

     RATIONAL15: Cleaning the bottle top reduces the risk for transmission of microorganisms into bottle. Covering top reduces risk of contamination.

ACTION16: Reapply the tourniquet approximately 3 to 4 inches above the identified puncture site. Apply sufficient pressure to impede venous circulation but not arterial blood flow. After disinfection, not palpate the venipuncture site unless sterile gloves are worn.

     RATIONAL16: Use of a tourniquet increases venous pressure to aid in vein identification. Tourniquet should remain in place no more than 60 seconds to prevent injury, stasis, and hemoconcentration, which may alter results. Palpation is the greatest potential cause of blood culture contamination.

ACTION17: Hold the patient’s arm in a downward position with your non-dominant hand. Align the butterfly needle with the chosen vein, holding the needle in your dominant hand. Use the thumb or first finger of the non-dominant hand to apply pressure and traction to the skin just below the identified puncture site. Do not touch the insertion site.

     RATIONAL17: applying pressure helps immobilize and anchor the vein. Taut skin at the entry site aids smooth needle entry. Not touching the insertion site helps to prevent contamination. Palpation is the greatest potential cause of blood culture contamination.

ACTION18: Inform the patient that he or she is going to feel a pinch. With the bevel of the needle up, insert the needle into the vein at a 15-degree angle to the skin. You should see a flash of blood in the extension tubing close to the needle when the vein is entered.

     RATIONAL18: Warning the patient prevents reaction related to surprise. Positioning the needle at the proper angle reduces the risk of puncturing through the vein. Flash of blood indicates entrance into the vein.

ACTION19: Grasp the butterfly needle securely to stabilize it in the vein with your nondominant hand, and push Vacutainer onto the first collection bottle (anaerobic bottle), until the rubber stopper on the collection bottle is punctured. You will feel the bottle push into place on the puncture device. Blood will flow into the bottle automatically.

     RATIONAL19: The collection bottle is a vacuum; negative pressure within the bottle pulls blood into the bottle.

ACTION20: Remove the tourniquet as soon as blood flows adequately into the bottle.

     RATIONAL20: Tourniquet removal reduces venous pressure and restores venous return to help prevent bleeding and bruising.

ACTION21: Continue to hold the butterfly needle in place in the vein. Once the first bottle is filled, remove it from the Vacutainer and insert the second bottle. After the blood culture specimens are obtained, continue to fill any additional required tubes, removing one and inserting another. Gently rotate each bottle and tube as you remove it.

     RATIONAL21: Filling the required bottles ensures that the sample is accurate. Gentle rotation helps to mix any additive in the tube with the blood sample.

ACTION22: After you have drawn all required blood samples, remove the last collection tube from the Vacutainer. Place a gauze pad over the puncture site and slowly and gently remove the needle from the vein. Engage the needle guard. Do not apply pressure to the site until the needle has been fully removed. 

     RATIONAL22: Slow, gentle needle removal prevents injury to the vein. Releasing vacuum before withdrawing the needle prevents injury to the vein and hematoma formation. Use of a needle guard prevents accidental needlestick injuries.

ACTION23: Apply gentle pressure to the puncture site for 2 to 3 minutes or until bleeding stop.

     RATIONAL23: Applying pressure to site after needle removal prevents injury, bleeding, and extravasation into the surrounding tissue, which can cause a hematoma.

ACTION24: After bleeding stops, apply an adhesive bandage.

     RATIONAL24: The bandage protects the site and aids in applying pressure.

ACTION25: Remove equipment and return the patient to a position of comfort. Raise side rail and lower bed.

     RATIONAL25: Repositioning promotes patient comfort. Raising rails promotes safety.

ACTION26: Discard Vacutainer and butterfly needle in sharps container.

     RATIONAL26: Proper disposal of equipment reduces transmission of microorganisms.

ACTION27: Remove gloves and perform hand hygiene.

     RATIONAL: Removing gloves properly reduces the risk for infection transmission and contamination of other items. Hand hygiene reduces the transmission of microorganisms.

ACTION28: Place label on the container per facility policy. Place containers in a plastic sealable biohazard bag. Refer to facility policy regarding the need for separate biohazard bags for blood culture specimens and other blood specimens.

     RATIONAL28: Proper labeling ensures accurate reporting of results. Packaging the specimen in a biohazard bag prevents the person transporting the container from coming in contact with blood or body fluids. Some facility policies call for individual bagging.

ACTION29: Check the venipuncture site to see if a hematoma has developed.

     RATIONAL29: Hematoma development requires further intervention.

ACTION30: Remove other PPE, if used. Perform hand hygiene.

     RATIONAL30: Removing PPE properly reduces the risk for infection transmission and contamination of other items. Hand hygiene reduces the transmission of microorganisms.

ACTION31: Transport specimen to the laboratory immediately. If immediate transport is not possible, check with laboratory personnel or policy manual as to appropriate handling.



Evaluation for Blood Culture Collection and Procedure

An adequate and uncontaminated blood specimen is obtained without adverse event and sent to the laboratory promptly. 

• The patient states the reason for blood test.

 • The patient exhibits minimal anxiety during specimen collection.

 • The patient verbalizes minor if any complaint of pain at the venipuncture site.

 • The patient exhibits no signs and symptoms of injury at the venipuncture site

Documentation for Blood Culture Collection and Procedure

Record the date, time, and site of the venipuncture; the name of the test(s); the time the sample was sent to the laboratory; the amount of blood collected, if required; and any significant assessments or patient reactions.

General Consideration for Blood Culture Collection and Procedure

1. Be aware that the size of the culture bottles may vary according to facility policy, but the sample dilution should always be 1:10. 

2.  Avoid using existing blood lines for cultures unless the sample is drawn when the line is inserted or catheter sepsis is suspected. 

3. Avoid collecting blood from edematous areas, arteriovenous shunts, an upper extremity on the same side as a previous lymph node dissection or mastectomy, infected sites, same extremity as an intravenous infusion, and sites of previous hematomas or vascular injury. 

4. Do not use veins in the lower extremities for venipuncture, because of an increased risk of thrombophlebitis. However, some facilities do allow collection from lower extremities with a physician’s order to collect blood from a leg or foot vein. Check your facility’s policies.

 5. Apply warm compresses to the selected site 15 to 20 minutes before venipuncture to aid in distending veins that are difficult to locate. 

6. Consider the use of topical anesthetic creams to minimize discomfort and pain for the patient, based on facility policy. Be familiar with requirements and specifications for particular product available for use. Application needs to occur far enough in advance to allow sufficient time to become effective.

7. Use distraction, which has been shown to be of benefit in reducing anxiety related to venipuncture, especially with children. Asking the patient to concentrate on relaxing, and performing deep breathing may help. Asking the patient to cough at the time of venipuncture is another technique that has shown to be effective in reducing pain with venipuncture.

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