NUH Critical Care – Standard Operating Procedure for Taking Blood Cultures

Indication A Systemic Inflammatory Response Syndrome (SIRS)* OR Evidence of organ failure potentially driven by an infection. *SIRS - Two or more of: Temp >38 or <36, Heart rate >90, Respiratory Rate >20 , White Cell Count <4 or >12 x109cells/L

Equipment -Clean Trolley -For each blood culture site: Sterile gloves Dressing pack Chloraprepp FREPP applicator or sani-cloth wipe (2% chlorhexidine in 70% isopropyl alcohol) Blood culture bottles 20ml syringe ONE sani-cloth wipe Completed micro form

Equipment -Additional for peripheral cultures: Disposable tourniquet hypodermic needle for venesection -Additional for each individual line culture: TWO 10 ml syringes

Insert pic of equipment

PREPARATION a. EQUIPMENT (as above – recommend surplus gloves, FREPP/Sanicloths and needles) b. HELP (an extra pair of hands if available) c. WASH HANDS (and usual bedside gown and glove barrier protection whilst preparing patient) d. PACK (open dressing pack and place FREPP/Sanicloth, needle and syringes therein) e. BOTTLES (take top off both culture bottles and wipe each top with separate sani- cloths) f. PLAN Peripheral culture: apply tourniquet and identify vein Line culture: decide aspiration point and align three way taps to allow aspiration PERFORM EACH BLOOD CULTURE SEPARATELY

Peripheral culture

Central line culture

PERFORM STERILE (Aquagel hands and allow hands to dry for 30 seconds, apply full arm apron AND sterile gloves) PERFORM: -PERIPHERAL CULTURE: i. FREPP or Sanicloth skin for 30 seconds and allow to evaporate for 30 seconds ii. Venesect 20 mls blood iii. Use gauze from pack to compress venesection site and release tourniquet (ideally with assistant) -LINE CULTURE (dirty hand and clean hand approach): i. Place drape from dressing pack under target aspiration port ii. Hold bionector/sampling-point in “dirty hand” using a swab from the dressing pack iii. Clean sampling point with FREPP or Sanicloth for 30 seconds and allow to evaporate for 30 seconds iv. Aspirate from port with 10 ml syringe until 5mls of blood have been cleared from sampling point v. Aspirate 20 mls blood into the clean 20ml syringe vi. Flush port (into clean 10ml syringe) and then flush line

COMPLETE a. INNOCULATE (10mls of blood into PURPLE(anaerobic) then GREY(aerobic) bottles – DO NOT CHANGE NEEDLE) b. MAKE SAFE (Dispose of sharps, flush and reset sampled lines) c. NEXT (PREPARE for next blood culture) d. TIDY (help tidy bedspace and wipe down trolley) e. NOTIFY (i. Label bottles ii. Sticker in notes iii. Bottles into collection box iv. Call porters (on 63211 at QMC)