Attaining a venous blood sample for blood culture

Introduction

• Wash hands
• Introduce self
• Patient’s name, DOB and wrist band
• Explain procedure and obtain consent
• Check for allergies (including chlorhexidine)
• Ask preferred (or non-dominant) arm 

Preparation 

• Wash hands thoroughly with soap and water
• Put on apron 
• Clean a trolley
• Clean tray thoroughly inside and out, clean sharps bin and place on trolley
• Gather equipment around tray (think through what you need in order)

Equipment list

• Gloves
• Tourniquet
• Alcohol 70%/chlorhexidine 2% skin-cleansing wipe
• Alcohol 70%/chlorhexidine 2% device disinfection wipe
• Green 21G Vacutainer butterfly needle
• Large Vacutainer holder
• Blood culture bottles (aerobic and anaerobic) – CHECK DATE AND MARK 10ML
• Sterile gauze
• Tape

• Wash hands
• Open packets and place neatly in tray, keeping items in plastic parts of packets (without touching the instruments themselves)
• Place Vacutainer holder on end of butterfly tubing
• Return to patient (with tray and sharps bin)

Procedure

Vein identification

• Wash hands 
• Expose arm and place a pillow beneath it
• Place tourniquet around patient’s arm 4-5 finger widths above intended venepuncture site (antecubital fossa is usually the easiest)
• Identify a suitable vein (i.e. one you can feel, not necessarily one you can see). NB: take sufficient time to find the best vein – this is the main determinant of whether you will be successful or not.
• Remove tourniquet

Taking blood culture

• Wash hands
• Put on gloves
• Sterilise area using skin-cleansing wipe (clean for 30 seconds, then allow to air-dry for 30 seconds)
• Remove caps of blood culture bottles and clean tops with device disinfection wipe
• Re-apply tourniquet
• Anchor the skin distally with your non-dominant hand and insert the needle at 10-30˚ to the skin with your dominant hand

Use your dominant hand to hold the butterfly wings steady on the patient’s arm. Then use your non-dominant hand to:

• Fill blood culture bottles (minimum requirement is 10ml) and invert them after filling. Fill the aerobic bottle first then anaerobic bottle to avoid getting air from the tube in the anaerobic bottle.
• Remove tourniquet after removing the last bottle 
• Place gauze loosely over the puncture site while you remove the needle. Then apply pressure to the gauze once the needle is fully removed.
• Put the needle immediately in the sharps bin
• Maintain pressure over the gauze until bleeding has stopped, then tape the gauze down over puncture site

To complete

• Thank patient and restore clothing
• Discard waste and clean tray; then discard gloves and apron; wash hands
• Fill in blood bottles, put in bags with printed request forms, send to lab
• Document procedure and tests requested in patient’s notes

Try a simulated station

1. Blood cultures
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