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Test Code M44 Blood Culture

Infectious

Additional Codes

ALAB: BLDCUL

PowerChart: Culture Blood

MA Cerner: Blood Culture.

Test Method

Screen for Positive: Bactec FX; BD

Confirmation: Vitek 2

Specimen Requirement

Preferred Collection Method:

Adult Routine: Direct draw into BD Bactec Plus Aerobic/F Bottle and then BD Bactec Plus Anaerobic/F Bottle bottle.

Collection Instructions:

  1. Prepare the BD Bactec Plus Aerobic/F bottle and  BD Bactec Plus Anaerobic/F Bottle by removing the plastic caps and wiping the tops of the bottles with 70% isopropyl alcohol. DO NOT USE IODINE. Use a fresh prep pad for each bottle.
  2. Apply the tourniquet and select the site for venipuncture. After the site is selected remove the tourniquet.

  3. Release the tourniquet and cleanse the venipuncture site with a chloraprep swab. Open chloraprep applicator package facing away from the patient while opening it, to avoid splashing or spraying of extra liquid onto the patient. Thoroughly cleanse the site for a full 30 seconds using a continuous back-and-forth/up-and-down friction scrub. Cover approximately a 3 inch area on the skin. Allow the area to dry for a full 30 seconds before performing the blood collection. Do not repalpate or touch the venipuncture site after cleansing. Do not use chlorapreps or iodine on babies less than 2 months old. Cleanse the site with 70% alcohol for 30 seconds using an up-down/back-and-forth motion, let dry and repeat with a new alcohol pad moving concentrically outward, and let dry again. Do not use ChloraPrep on patients with known allergies to chlorhexidine gluconate or isopropyl alcohol.

  4. Re-apply the tourniquet and avoid touching the cleansed venipuncture site. If the site must be palpated again, thoroughly clean the gloved finger with a chloraprep applicator swab and let dry.

  5. Remove the needle guard and perform the venipuncture.

  6. Blood is routinely collected directly into the blood culture media using a winged blood collection set with multiple luer adapter and a single use tube holder.

  7. Fill the aerobic bottle first and then the anaerobic bottle so that oxygen in the tubing will not be introduced into the anaerobic bottle.

  8. Completely fill each bottle with 8-10 mL of blood. Do not overfill. Avoid backflow by keeping the culture bottle lower than the collection site. Do not allow the blood culture media to contact the stopper or needle during collection.

  9. Mix the bottle contents by inverting the bottles 4-5 times.
  10. Label the tubes with patient’s name, a second identifier (patient ID, DOB, etc.), date/time of collection and initials of the person collecting the specimen.

  11. Transport to the lab as quickly as possible.

Alternate Collection Method:

Adult Routine: 8.3 mL of blood is drawn into each of two yellow-top vacuum tubes containing SPS which acts as an anticoagulant.

Collection procedure:        

  1. The venipuncture materials should be prepared by first wiping off the top of the two SPS vacuum tubes with iodine. DO NOT USE ALCOHOL. Allow the tubes to air dry.
  2. Apply the tourniquet and select the site for venipuncture. After the site is selected release the tourniquet.
    Avoid collecting blood through indwelling intravenous or intra-arterial catheters unless blood cannot be obtained by venipuncture. Make a notation on the requisition.
  3. Cleanse the venipuncture site with a chloraprep swab. Open chloraprep applicator package facing away from the patient while opening it, to avoid splashing or spraying of extra liquid onto the patient. Thoroughly cleanse the site for a full 30 seconds using a continuous back-and-forth/up-and-down friction scrub. Cover approximately a 3 inch area on the skin. Allow the area to dry for a full 30 seconds before performing the blood collection. Do not repalpate or touch the venipuncture site after cleansing.
  4. Re-apply the tourniquet and avoid touching the cleansed venipuncture site. If the site must be palpated again, thoroughly clean the gloved finger with a chloraprep applicator swab and let dry. Do not use chlorapreps or iodine on babies less than 2 months old. Cleanse the site with 70% alcohol for 30 seconds using an up-down/back-and-forth motion, let dry and repeat with a new alcohol pad moving concentrically outward, and let dry again.
  5. Remove the needle guard and perform the venipuncture. Fill two SPS vacuum tubes completely making sure to adequately mix the tubes 4-5 times.
  6. Label the tubes with patient’s name, a second identifier (patient ID, DOB, etc.), date/time of collection and initials of the person collecting the specimen.
  7. Transport to the lab as quickly as possible. If SPS vacuum tubes are used the lab will transfer the sample into the Bactec bottles when received.

Additional Specimen Collection Information

The optimal time for the collection of blood cultures is as soon as possible after the onset of fever or chills or whenever serious infection is suspected. Most cases of bacteremia are detected by using two to three sets of separately collected blood cultures drawn in the initial 24 hour period of onset. More than three sets of blood cultures yield little additional information. Conversely, a single blood culture may miss intermittently occurring bacteremia and make it difficult to interpret the clinical significance of certain isolated organisms. The ideal time interval between blood collections is 30-60 minutes; however in medically urgent situations in which antibiotic therapy is to be started immediately in the critically ill patient, two separate blood culture specimens are collected within a few minutes and then antibiotic therapy is started. When two or more specimens are collected within a few minutes, these collections are made separately and collected from different arms.

  • Volume of Blood: The volume of blood is critical because the concentration of organisms in most cases of bacteremia is low, especially if the patient is on antimicrobial therapy. the concentration of organisms in infants and children during bacteremia is higher than in adults, so less blood is required for culture.
  • Difficult Draws, Pediatric Patients and Neonates: SPS yellow-top vacuum tubes should not be used for difficult draws, pediatric patients or neonates. Blood should be drawn directly into the BD Bactec bottles. Patients that fall under this category should be referred to a laboratory for the venipuncture.
  • Fungus: If a fungus only blood culture is ordered, collect 2 BD Bactec Plus Aerobic/F bottles or 2 SPS yellow-top vacuum tubes. If a Fungus Culture, Blood is ordered in addition to a routine Blood Culture, no extra tubes are required and the specimens are collected and handled as outlined above for adult - routine. A notation must be made on the requisition designating that the culture is a Fungus Culture, Blood.
  • Mycobacteria: If a request for a mycobacteria culture (Acid-Fast Culture) is received, collect 1 SPS yellow-top vacuum tube and transport to Microbiology immediately.

Performance

Blood Culture: 

  • Final Negative: After 5 day.
  • Preliminary Positive: When growth is detected.

Fungus: 4 weeks

Mycobacterium: 6 weeks

Reference Values

No growth

  • Critical Value: Growth

All positive Blood Cultures are called to the physician office or nursing station as soon as growth is detected. Any bacterial growth is identified and MICs are performed when appropriate.

CPT Code Information

87040 Identification of Microorganisms; Culture, bacterial; blood aerobic, with isolation and presumptive identification of isloates (includes anaerobic culture, if appropriate)

Useful For

Detection of microorganism in blood specimens.

LOINC Code Information

600-7 Bacteria Identified In Blood By Culture

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