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CDHB

Blood Culture Collection

• Blood cultures should ideally be taken via the vacutainer compatible (safety) butterfly method, rather than using a needle and syringe, which may result in poorer quality samples and risk to the staff member.

  Note: If safety butterfly is not used, extreme caution is required to ensure a needlestick injury does not occur during disposal.

• It is important to avoid air being injected into the anaerobic bottle - with a butterfly there is often air in the tube, and with the syringe method there is often air in the plunger end. Therefore:
  • If using the butterfly method, aseptically inoculate the aerobic bottle first.
  • If using the syringe method, aseptically inoculate the anaerobic bottle first.
• Taking 2 to 3 blood culture sets improves the sensitivity of the test. If taking multiple blood cultures, repeat the whole procedure at different sites, preferably a few minutes apart for acute sepsis and an hour or two apart for acute endocarditis. Taking samples before giving antibiotics also improves sensitivity but therapy should never be delayed in an acutely ill patient.

Vacutainer Compatible (Safety) Butterfly Blood Culture Technique

Assemble the equipment:

• Vacutainer compatible safety butterfly
• 3 alcohol swabs
• Tourniquet
• Blood culture bottles
• Routine blood tubes, if required
• Vacutainer hub, sharps container, tape, and bandaid/plaster.
• Plastic transport container, 1 for each bottle.

Ensure that you have the vacutainer compatible safety butterfly, then:

• Wash hands before procedure.
• Thread the vacutainer compatible safety butterfly onto the Vacutainer hub.
• Remove caps from blood culture bottles. Swab each bottle with approved alcohol based skin wipe and leave swab on top of bottle until ready for use.
• Apply tourniquet 10 cm above proposed venepuncture site and vigorously swab skin using alcohol based skin wipe. Use a circular motion to at least 3 cm around the vein to be accessed. Allow to dry and do not touch the area with fingers before inserting the butterfly needle.
• Put on non-sterile gloves.
• Access the vein with the butterfly and secure the wing in place with tape (optional).

  Important: Ensure that the blood culture bottles remain upright.

• Push and hold the hub firmly onto the blood culture bottle and fill each bottle with 10 mL of blood (incremental markings are on the side of the culture bottles).
• Aseptically inoculate the aerobic bottle first and then the anaerobic bottle (as there may be air in the butterfly tubing that will get into the first bottle).
• If routine blood tubes are also required, fill subsequent tubes in correct order of draw following the cultures. Invert gently to mix.
• Undo the tourniquet.
• Remove the tape. While the needle is still in the vein, activate the push button to retract the needle. Withdraw the butterfly from the vein. Apply plaster. Immediately discard entire unit into sharps container.
• Place filled bottle into plastic transport container and send to lab immediately. Do not refrigerate.

Peripheral Blood Culture Technique (Syringe Method)

• Wash hands before and after the procedure. Examination gloves should be worn to protect yourself.
• Remove caps from blood culture bottles. Swab each bottle with approved alcohol based skin wipe and leave swab on top of bottle until ready for use.
• Apply tourniquet 10 cm above proposed venepuncture site and vigorously swab skin using alcohol based skin wipe. Use a circular motion to at least 3 cm around the vein to be accessed. Allow to dry and do not touch the area with fingers before inserting the needle and until after the needle has been removed.
• Draw 20 mL of blood into the syringe. Do not press down on the venepuncture site whilst removing the needle as this may damage the vein. Do not allow the skin wipe to touch the needle as the needle is withdrawn. Do not change the needle.
• Fill each bottle with 10 mL blood (i.e., 20 mL per set). Aseptically inoculate the anaerobic bottle first when using a syringe, then the aerobic bottle. Inoculate blood culture bottles before other blood tubes.
• Place filled bottle into plastic transport container and send to lab immediately. Do not refrigerate.

Topic Code: 9479