Test Number

EPIC Code: LAB4674

Specimen Type

   BACT/ALERT FA (pale green) BACT/ALERT FN (Orange) Pediatrics >80 lbs and Adults
                      
  BACT/ALERT PF - PEDIATRIC <80 lbs. (DO NOT USE ON ADULTS)
           

Other Acceptable Specimen(s)

Single Aerobic Blood Culture bottle filled to the minimum volume. This is not optimal and should be reserved for very difficult draws.

Specimen Preparation

Precollection Requirements
Timing of Specimen Collection
  • Specimens for blood cultures should be collected simultaneously (or over a short time frame).
  • Drawing blood at intervals is indicated only when it is necessary to document continuous bacteremia in patients with suspected infective endocarditis or other endovascular infections.
  • Blood culture collection prior to administration of antimicrobials is essential for optimal organism recovery
Pediatric Blood Culture Bottles
For pediatric patients with blood stream infection (BSI), two to three blood culture sets should be obtained within 24-hour period.
  • It is common practice to draw the minimum amounts of blood from pediatric patients.  For babies and children, the blood volume drawn should not exceed 1% of the patient’s blood volume.
  • The pediatric standard volume needed for culture is 4 mL.
Number of Blood Culture Sets
For adult patients with suspected blood stream infection (BSI), the current recommendation is to obtain two to three blood culture sets per episode within a 24-hour period.
  • Multiple sets should always be obtained to ensure adequate blood volume.  Results of a single blood culture set are more difficult to interpret than results of multiple sets.
  • Follow-up blood culture sets should not be repeated for two to five days after initial sets are obtained. Blood does not immediately become sterile after antimicrobial therapy is initiated.
Volume of Blood for Culture
The blood volume is the most important variable in detecting bacteremia and fungemia.
  • For adults, the required volume is 20 to 30 mL per culture set.
  • For newborn, infants and children, the blood volume drawn should be no more than 1% of the patient’s total blood volume.  See table below.
Weight in Kg. (lbs.) Venipuncture Culture Set Total
< 1 (2.2 lbs) 1 site Pediatric bottle 2ml
1.1-2 (2.4-5lbs) 2 sites 2mL per Pediatric Bottle 4ml
2.1 -12.7 (5-28 lbs) 2 sites 3 mL per Pediatric Bottle 6ml
12.8-36.3 (28-80 lbs) 2 sites 5 mL per Pediatric Bottle 10ml
>36.3 (>80 lbs.) Follow adult collection    

Collect

Prior to collection, the skin must be prepared following the Patient Preparation guidelines.
Strict adherence to the skin prep is required.

Select a different venipuncture site for each culture set.
For Adults, at least two blood culture sets should be obtained.
  • The maximum per 24 hours is 4 Sets.
Immediately before venipuncture prepare the bottles and skin:
Blood culture bottle preparation:
  • Remove plastic flip-top from each of the blood culture bottles.
  • Disinfect the rubber septum of each bottle using 70% isopropyl alcohol by rubbing the septum with friction.
  • Allow the alcohol to air dry.
Skin Preparation: 
Vein selection MUST occur prior to preparing the skin.
DO NOT palpitate the vein after the skin is prepared.
​​​​​​
ADULT skin prep:
Proper Skin preparation is essential in avoiding contamination:
1. Vigorously cleanse the venipuncture site with friction for 30 seconds using 70% isopropyl alcohol pad.
2. Allow the alcohol to air dry.
3. Apply the SECOND disinfectant. Using a circular motion cleanse the site using chlorhexidine gluconate in isopropyl alcohol.

PEDIATRIC skin Prep (>80 lbs):
1. DO NOT use chlorhexidine gluconate
2. Cleanse with 70% isopropyl alcohol pad
3. Allow the alcohol to air dry
4. Cleanse for a 2nd time using 70% isopropyl alcohol pad
5. Allow the alcohol to air dry.

Venipuncture:
1. Collect the blood using a butterfly blood and a blood collection adapter.
2. Follow proper blood collection protocol to complete the venipuncture 
3. Inoculate the AEROBIC (pale green) bottle first for Adults 
4. Inoculate the ANAEROBIC (orange) bottle second for Adults.
5. Hold the bottle at a postion below the patient's arm with the bottle upright.
  • Fill each bottle to the fill line
    • AVOID over or UNDER inoculation.
6. Once both bottle are filled you may collect additonal blood samples using the blood culture adaptor 
  • Use caution when filling standard tubes ensure you are pushing each tube on straigh as the fit will be loose.
7. Upon completion of the blood draw, mix each bottle thoroughly. DO NOT SHAKE
8. Label each bottle with the lab labels. Proper positioning is important.
  • Place the lab label vertically in the designated area of the bottles. The orientaiton must be the same as the bottle barcode.

 

Unacceptable Conditions

Rejection Criteria:
Blood culture bottles that are not labeled or incorrectly labeled
Blood culture bottles beyond the expiration date indicated
Broken, Cracked or Leaking bottles
Anaerobic Bottle submitted without an Aerobic.

NOTE: Blood culture bottles are not rejected due to insufficient volume or number of bottles. Micro staff will add the appropriate comments.

Pediatric Collection

PEDIATRIC skin Prep (>80 lbs):
1. DO NOT use chlorhexidine gluconate
2. Cleanse with 70% isopropyl alcohol pad
3. Allow the alcohol to air dry
4. Cleanse for a 2nd time using 70% isopropyl alcohol pad
5. Allow the alcohol to air dry.

Venipuncture:
1. Collect the blood using a butterfly blood and a blood collection adapter.
2. Follow proper blood collection protocol to complete the venipuncture 
3. Pediatric Blood culture bottle (YELLOW)
5. Hold the bottle at a postion below the patient's arm witht eh bottle upright.
  • Fill the bottle to the appropriate volume using the chart below:
Weight in Kg. (lbs.) Venipuncture Culture Set Total
< 1 (2.2 lbs) 1 site Pediatric bottle 2ml
1.1-2 (2.4-5lbs) 2 sites 2mL per Pediatric Bottle 4ml
2.1 -12.7 (5-28 lbs) 2 sites 3 mL per Pediatric Bottle 6ml
12.8-36.3 (28-80 lbs) 2 sites 5 mL per Pediatric Bottle 10ml
>36.3 (>80 lbs.) Follow adult collection    
  • AVOID over or UNDER inoculation.
6. Once both bottle are filled you may collect additonal blood samples using the blood culture adaptor 
  • Use caution when filling standard tubes ensure you are pushing each tube on straigh as the fit will be loose.
7. Upon completion of the blood draw, mix each bottle thoroughly. DO NOT SHAKE
8. Label each bottle with the lab labels. Proper positioning is important.
  • Place the lab label vertically in the designated area of the bottle. The orientaiton must be the same as the bottle barcode.

 

Notes/Comments

  • Blood Culture Collection must be performed to maximize pathogen detection and minimize the risk of contamination.
  • When possible, specimens should be collected before antimicrobial agens are administered.
  • Specimens for blood culture must be collected first before any additional tubes
  • Always fill the Aerobic (pale green) bottle first followed by Anerobic (orange) bottle.
  • If poor access requires that blood for culutre be drawn through a port in an indwelling catheter, the second sampe must be from a peripheral site. Samples drawn through cathereters can indicate catheter colonization but may not be indicative of sepsis.
  • Do NOT draw blood from vein in which an intravenous solution is running.
  • Except for neonates, draw the two blood samples in succession.
    • If a second venipuncture site is not an option, perform a new venipuncture in the same site.

 

Storage/Transport Temperature

Blood culture bottles must be transported and stored at room temperature.
Blood culture bottles must be transported to the lab within 2hrs of collection.

Department

Microbiology

Patient Preparation

Vein selection MUST occur prior to preparing the skin.
DO NOT palpitate the vein after the skin is prepared.

ADULT skin prep:
Proper Skin preparation is essential in avoiding contamination:
1. Vigorously cleanse the venipuncture site with friction for 30 seconds using 70% isopropyl alcohol pad.
2. Allow the alcohol to air dry.
3. Apply the SECOND disinfectatnt. Using a circular motion cleanse the site using chlorhexidine gluconate in isopropyl alcohol.

PEDIATRIC skin Prep (>80 lbs):
1. DO NOT use chlorhexidine gluconate
2. Cleanse with 70% isopropyl alcohol pad
3. Allow the alcohol to air dry
4. Cleanse for a 2nd time using 70% isopropyl alcohol pad
5. Allow the alcohol to air dry.
Collection

Test Number

EPIC Code: LAB4674

Specimen Type

   BACT/ALERT FA (pale green) BACT/ALERT FN (Orange) Pediatrics >80 lbs and Adults
                      
  BACT/ALERT PF - PEDIATRIC <80 lbs. (DO NOT USE ON ADULTS)
           

Other Acceptable Specimen(s)

Single Aerobic Blood Culture bottle filled to the minimum volume. This is not optimal and should be reserved for very difficult draws.

Specimen Preparation

Precollection Requirements
Timing of Specimen Collection
  • Specimens for blood cultures should be collected simultaneously (or over a short time frame).
  • Drawing blood at intervals is indicated only when it is necessary to document continuous bacteremia in patients with suspected infective endocarditis or other endovascular infections.
  • Blood culture collection prior to administration of antimicrobials is essential for optimal organism recovery
Pediatric Blood Culture Bottles
For pediatric patients with blood stream infection (BSI), two to three blood culture sets should be obtained within 24-hour period.
  • It is common practice to draw the minimum amounts of blood from pediatric patients.  For babies and children, the blood volume drawn should not exceed 1% of the patient’s blood volume.
  • The pediatric standard volume needed for culture is 4 mL.
Number of Blood Culture Sets
For adult patients with suspected blood stream infection (BSI), the current recommendation is to obtain two to three blood culture sets per episode within a 24-hour period.
  • Multiple sets should always be obtained to ensure adequate blood volume.  Results of a single blood culture set are more difficult to interpret than results of multiple sets.
  • Follow-up blood culture sets should not be repeated for two to five days after initial sets are obtained. Blood does not immediately become sterile after antimicrobial therapy is initiated.
Volume of Blood for Culture
The blood volume is the most important variable in detecting bacteremia and fungemia.
  • For adults, the required volume is 20 to 30 mL per culture set.
  • For newborn, infants and children, the blood volume drawn should be no more than 1% of the patient’s total blood volume.  See table below.
Weight in Kg. (lbs.) Venipuncture Culture Set Total
< 1 (2.2 lbs) 1 site Pediatric bottle 2ml
1.1-2 (2.4-5lbs) 2 sites 2mL per Pediatric Bottle 4ml
2.1 -12.7 (5-28 lbs) 2 sites 3 mL per Pediatric Bottle 6ml
12.8-36.3 (28-80 lbs) 2 sites 5 mL per Pediatric Bottle 10ml
>36.3 (>80 lbs.) Follow adult collection    

Collect

Prior to collection, the skin must be prepared following the Patient Preparation guidelines.
Strict adherence to the skin prep is required.

Select a different venipuncture site for each culture set.
For Adults, at least two blood culture sets should be obtained.
  • The maximum per 24 hours is 4 Sets.
Immediately before venipuncture prepare the bottles and skin:
Blood culture bottle preparation:
  • Remove plastic flip-top from each of the blood culture bottles.
  • Disinfect the rubber septum of each bottle using 70% isopropyl alcohol by rubbing the septum with friction.
  • Allow the alcohol to air dry.
Skin Preparation: 
Vein selection MUST occur prior to preparing the skin.
DO NOT palpitate the vein after the skin is prepared.
​​​​​​
ADULT skin prep:
Proper Skin preparation is essential in avoiding contamination:
1. Vigorously cleanse the venipuncture site with friction for 30 seconds using 70% isopropyl alcohol pad.
2. Allow the alcohol to air dry.
3. Apply the SECOND disinfectant. Using a circular motion cleanse the site using chlorhexidine gluconate in isopropyl alcohol.

PEDIATRIC skin Prep (>80 lbs):
1. DO NOT use chlorhexidine gluconate
2. Cleanse with 70% isopropyl alcohol pad
3. Allow the alcohol to air dry
4. Cleanse for a 2nd time using 70% isopropyl alcohol pad
5. Allow the alcohol to air dry.

Venipuncture:
1. Collect the blood using a butterfly blood and a blood collection adapter.
2. Follow proper blood collection protocol to complete the venipuncture 
3. Inoculate the AEROBIC (pale green) bottle first for Adults 
4. Inoculate the ANAEROBIC (orange) bottle second for Adults.
5. Hold the bottle at a postion below the patient's arm with the bottle upright.
  • Fill each bottle to the fill line
    • AVOID over or UNDER inoculation.
6. Once both bottle are filled you may collect additonal blood samples using the blood culture adaptor 
  • Use caution when filling standard tubes ensure you are pushing each tube on straigh as the fit will be loose.
7. Upon completion of the blood draw, mix each bottle thoroughly. DO NOT SHAKE
8. Label each bottle with the lab labels. Proper positioning is important.
  • Place the lab label vertically in the designated area of the bottles. The orientaiton must be the same as the bottle barcode.

 

Unacceptable Conditions

Rejection Criteria:
Blood culture bottles that are not labeled or incorrectly labeled
Blood culture bottles beyond the expiration date indicated
Broken, Cracked or Leaking bottles
Anaerobic Bottle submitted without an Aerobic.

NOTE: Blood culture bottles are not rejected due to insufficient volume or number of bottles. Micro staff will add the appropriate comments.

Pediatric Collection

PEDIATRIC skin Prep (>80 lbs):
1. DO NOT use chlorhexidine gluconate
2. Cleanse with 70% isopropyl alcohol pad
3. Allow the alcohol to air dry
4. Cleanse for a 2nd time using 70% isopropyl alcohol pad
5. Allow the alcohol to air dry.

Venipuncture:
1. Collect the blood using a butterfly blood and a blood collection adapter.
2. Follow proper blood collection protocol to complete the venipuncture 
3. Pediatric Blood culture bottle (YELLOW)
5. Hold the bottle at a postion below the patient's arm witht eh bottle upright.
  • Fill the bottle to the appropriate volume using the chart below:
Weight in Kg. (lbs.) Venipuncture Culture Set Total
< 1 (2.2 lbs) 1 site Pediatric bottle 2ml
1.1-2 (2.4-5lbs) 2 sites 2mL per Pediatric Bottle 4ml
2.1 -12.7 (5-28 lbs) 2 sites 3 mL per Pediatric Bottle 6ml
12.8-36.3 (28-80 lbs) 2 sites 5 mL per Pediatric Bottle 10ml
>36.3 (>80 lbs.) Follow adult collection    
  • AVOID over or UNDER inoculation.
6. Once both bottle are filled you may collect additonal blood samples using the blood culture adaptor 
  • Use caution when filling standard tubes ensure you are pushing each tube on straigh as the fit will be loose.
7. Upon completion of the blood draw, mix each bottle thoroughly. DO NOT SHAKE
8. Label each bottle with the lab labels. Proper positioning is important.
  • Place the lab label vertically in the designated area of the bottle. The orientaiton must be the same as the bottle barcode.

 

Notes/Comments

  • Blood Culture Collection must be performed to maximize pathogen detection and minimize the risk of contamination.
  • When possible, specimens should be collected before antimicrobial agens are administered.
  • Specimens for blood culture must be collected first before any additional tubes
  • Always fill the Aerobic (pale green) bottle first followed by Anerobic (orange) bottle.
  • If poor access requires that blood for culutre be drawn through a port in an indwelling catheter, the second sampe must be from a peripheral site. Samples drawn through cathereters can indicate catheter colonization but may not be indicative of sepsis.
  • Do NOT draw blood from vein in which an intravenous solution is running.
  • Except for neonates, draw the two blood samples in succession.
    • If a second venipuncture site is not an option, perform a new venipuncture in the same site.

 

Storage/Transport Temperature

Blood culture bottles must be transported and stored at room temperature.
Blood culture bottles must be transported to the lab within 2hrs of collection.

Department

Microbiology
Result Interpretation
Administrative
Patient Preparation

Patient Preparation

Vein selection MUST occur prior to preparing the skin.
DO NOT palpitate the vein after the skin is prepared.

ADULT skin prep:
Proper Skin preparation is essential in avoiding contamination:
1. Vigorously cleanse the venipuncture site with friction for 30 seconds using 70% isopropyl alcohol pad.
2. Allow the alcohol to air dry.
3. Apply the SECOND disinfectatnt. Using a circular motion cleanse the site using chlorhexidine gluconate in isopropyl alcohol.

PEDIATRIC skin Prep (>80 lbs):
1. DO NOT use chlorhexidine gluconate
2. Cleanse with 70% isopropyl alcohol pad
3. Allow the alcohol to air dry
4. Cleanse for a 2nd time using 70% isopropyl alcohol pad
5. Allow the alcohol to air dry.

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