1. NUH Critical Care – Standard Operating Procedure for Taking Blood Cultures

2. 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

3. 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

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

5. Insert pic of equipment

6. 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

7. Peripheral culture

8. Central line culture

9. 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

10. 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 at QMC)