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Transcript
Appendix D: UNIVERSITY OF WISCONSIN HOSPITAL & CLINICS AND CHILDREN’S HOSPITAL
BEST PRACTICES FOR BLOOD CULTURING
•
•
•
•
•
SURVEILLANCE CULTURES ARE NOT USEFUL AND SHOULD NOT BE ORDERED.
STANDING ORDERS ARE NOT APPROPRIATE FOR BLOOD CULTURES.
WHEN TO OBTAIN CULTURES
NEW ONSET OF FEVER (≥38.2º°C)
WITH OR WITHOUT OTHER
SIGNS OF SEPSIS (rigors, hypotension,
leukocytosis, mental status change,
oliguria, hypoxia, tachypnea or metabolic
acidosis)
REPEATED CULTURING OF
NEUTROPENIC PATIENTS IS
UNNECESSARY, UNLESS THERE
IS A NEW ONSET OF FEVER
“Test of cure” cultures are warranted
ONLY if the patient has endocarditis, S.
aureus or fungal sepsis or continued
signs and symptoms of sepsis despite
antiinfective therapy. Begin 48 hour after
last positive blood culture and
discontinue after 2 negative cultures.
Weight
Category
A
B
C
C’ (Special Peds)*
Weight Category
D
E
•
•
•
•
•
TIMING OF BLOOD CULTURES
DRAW ONLY DURING A FEBRILE
EPISODE, ideally before fever abates.
If patient has endocarditis or intravascular
device-related sepsis, cultures may be drawn any
time.
CULTURES MUST BE DRAWN FROM
TWO SEPARATE SITES; VENIPUNCTURE
IS BY FAR THE PREFERRED SPECIMEN
BECAUSE LINES ARE TWICE AS LIKELY
TO YIELD CONTAMINANTS.
TWO SETS (40 mL TOTAL) IS THE
VOLUME NEEDED TO DIAGNOSIS
SEPSIS; LARGER VOLUMES ARE
UNNECESSARY
Surveillance cultures should not be requested
•
•
•
•
SITES AND NUMBER
Inoculate one culture set from each of
two separate sites.
VENIPUNCTURES ARE
PREFERRED BECAUSE OF
LOWER CONTAMINATION RATES
If venous access is severely limited,
draw one via venipuncture and one
through a line
If venous access is unavailable, draw one
through each of two separate lines
When one or both specimens are from
lines, specimens must be of equal
volume, drawn within 10 min of one
another, and sent together or in
immediate succession.
BLOOD CULTURE FOR BACTERIA AND YEAST (e.g., Candida and Cryptococcus)
Patient weight
Blood culture set 1
Blood culture set 2
(kg)
(pediatric) bottle
Purple (anaerobic) bottle
(pediatric) bottle
Purple (anaerobic)
(mL)
(mL)
(mL)
bottle (mL)
1.5
0.5
≤1
1.1-2.0
1.5
1.5
1.5
2.1-12.7
1.5
3.0
1.5
12.8-20.0
1.5
3.0
1.5
3.0
Patient weight
Blue (aerobic)
Purple (anaerobic) bottle
Blue (aerobic)
Purple (anaerobic)
(kg)
bottle (mL)
(mL)
bottle (mL)
bottle (mL)
12.8-36.3
6.5
5.0
6.5
5.0
>36.3
10
10
10
10