Blood Culture Bottles Which First

Collection and Inoculation of Blood Specimens for Routine Culture (Bacterial, T.B. or Fungus)

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Equipment
  • Prescriptions for laboratory services
  • Name labels
  • Safety Lok Blood Collection Set/Saf-T E-Z Set
  • Angel Wing
  • Blood Culture Bottles*
  • Prescriptions for laboratory services Skin prep kit (ChloraPrep One-Step FreppTM)
  • Tourniquet
  • Gauze and paper tape
  • Unsterile examination gloves

Prescriptions for laboratory services; name labels; Safety Lok Blood Collection Set/Saf-T E-Z Set; Angel Wing; Blood Culture Bottles*; Prescriptions for laboratory services Tourniquet, gauze, and paper tape; unsterile examination gloves; skin prep kit (ChloraPrep One-Step FreppTM);

Recommended Testing

  1. Adults with suspected bacteremia should have two sets of blood culture bottles drawn (one for aerobic bacteria and one for anaerobic bacteria) from two different venipuncture sites. There is a limit of four cultures. It is necessary to inoculate the aerobic bottle first since there is approximately 0.5 cc of air in the line of the collection set and it is sometimes difficult to extract 8-10 cc of blood per bottle (15-20 cc/set) when using the aerobic bottle. The aerobic bottle is the one that must be inoculated with brief samples since it contains the most bacteria. On the label, little lines signify roughly 5 cc, and there is a fill line that is marked by a line in the middle of the label. It is critical not to underfill or overfill the bottles, since this might have a negative impact on the outcome. One aerobic (yellowtop) bottle per pediatric/neonatal patient, as directed by the physician, is required. Amount of blood recommended per bottle: 1 to 2 cc of blood
  2. Blood Culture for Tuberculosis: two heparin-coated (green top) or two SPS-coated (yellow top) Vacutainers each. No more than once every 24 hours
  3. No more than once every 48 hours
  4. In order to test for fungus, one aerobic (bluetop) blood culture bottle must be used.
Method/Procedure
  1. Confirm the patient’s identify by checking the requisition and labels to ensure that they match the name bracelet
  2. Provide the patient with an explanation of the procedure. Choose a location for the venipuncture
  3. Remove the cap(s) off the bottle(s) and wipe the bottle top(s) with a prep pad with 70 percent alcohol
  4. Preparation of the skin and collection of specimens/inoculation:
  1. Identify the vein that will be utilized
  2. FreppTM should be removed from the bundle. When you hold the applicator in your hand, with the ChloraPrep One-Step FreppTM sponge facing downwards, gently press the wings to release fluid for a regulated flow. In order to soak the sponge, place it on the specified venipuncture site and depress once or twice. For at least 30 seconds, use a back and forth friction scrub technique. Allow approximately 30 seconds for the area to dry once it has been prepped. Continue with the collecting of blood
  1. It is not necessary to clean off since doing so will infect the location.
  1. Maintain a “hands-off” attitude during the preparation process. To palpate above and below the needle insertion site if it is required to contact the cleaned site, prep the glove finger in the same manner as before with a fresh prep pad and just palpate above and below
  2. A. Drawing on the Periphery 1. Perform the venipuncture using the butterfly Safety E-Z Collection Set and a “male” Angel Wing, as directed by the manufacturer. Blood should “flash” back into the tubing at the end of the tube. 2. Start with the aerobic bottle and then attach the blood culture bottles to the adapter. Collect 10 cc of blood into each vial and set it aside. Note: Collect blood in the aerobic bottle first since there is approximately 0.5 cc of air in the line of the butterfly, and in the event that less than 10 cc is collected, collect blood in the aerobic bottle second. A notation should be included on the request if less than 10 cc of blood is obtained from an adult patient since this might result in a false negative test result. c. Drawing a Line The following are the two approaches for drawing from a line: 1. Directly attach the “male” angel wing to the clave connection by inserting the wing directly into the connector. OR Secondly, insert the syringe into the clave and draw back the specimen. Then, remove the syringe and insert a “female” angel wing into the syringe. Place the blood in the appropriate containers. After the operation is completed, use an alcohol prep to remove any blood that may have accumulated on the gray stopper of the blood culture bottles. Label the bottle(s) with the patient’s name, patient number, the time and date, and the location of the specimen collection site, such as “right arm” or “left arm,” if appropriate. When drawing lines, always specify which line and/or port is being drawn. Position the label vertically on the bottle, and DO NOT place the label over the bar code on the blood culture vial (unless otherwise specified). Note: After the culture is taken from the identified patient, apply the patient label to the bottles at the bedside
  3. If further blood cultures are necessary, pull the extra tubes after the blood cultures are obtained.
TYPE OF CULTURE CONTAINER AMOUNT OF BLOOD ROUTE
Aerobic Blue top Bottle 8-10 cc. Blood Peripheral Or Line
Anaerobic Fuchsia top Bottle 8-10 cc. Blood Peripheral Or Line
Fungus Blue top Bottle 8-10 cc. Blood Peripheral Or Line
TB or AFB or Mycobacterium 2 green Vacutainer Tubes (Heparin) 7-10 cc. Blood Peripheral Or Line
Pediatric Blood Culture Yellow top Bottle 1-2 cc. Blood Peripheral Or Line

Updated on November 24, 2017

Blood Culture


Background: Properly obtained blood cultures are important to identify organisms and to ensure proper antimicrobial/antifungal coverage while minimizing false positive results.Principle Preparation of the skin for venipuncture is important to prevent contamination of blood cultures by bacteria that normally lie on the skin and to prevent introduction of these bacteria into the patient’s bloodstream.Patient Identification: Follow the HFHS Patient Identification Policy (HFHS Administrative Policies – Clinical Practice) to properly identify the patient.Follow the Department of Pathology specimen labeling policy to properly label each bottle with patient identification and collect time and date before the blood is drawn. Specimen Logistics Blood cultures should be drawn prior to initiation of antimicrobialtherapy.Preparation of skin prior to blood culture collection is important toprevent contamination of sample. At least two (2) sets of blood cultures should be obtained (each setincludes one (1) aerobic and one (1) anaerobic bottle).Each set of blood cultures are to be drawn from two separatevenipuncture sites at approximately 15 minutes apart.If two separate venipunctures are not able to be drawn, the providermust be notified, and collaboration should be done to determine if two sets arenecessary. Central lines (includes dialysis lines and Mediports) and PeripherallyInserted Central Catheters (PICCs)shouldnotbe used to obtain blood cultures due to the high probability ofcolonization and the likelihood of false positive results.Central lines from outside facilities may be cultured for up to two (2)calendar days (as opposed to 48 hours), after admission by provider order onlyfor a positive blood culture to be considered present on admission.Blood culture volume is essential. There is a 3% increase in sensitivityfor every extra mL collected. Blood culture bottles require 8- 10 mLs. to beaccurate. After positive blood cultures have been identified wait at least 48hours to draw any additional blood cultures. Surveillance blood cultures should not be routinely done.KEY POINT: Neutropenic (ANC1500 µL) orthrombocytopenic (Platelets30,000 µL) patients suspected of having ablood stream infection are to have peripheral blood culture attempted twicebefore considering drawing a blood culture from a central line or PICC. It isimperative that cultures in these patients are drawn within an hour ofsuspected infection has been identified.Do not send catheter tips for culture.Escalation orderof blood culture sites, General Practice Unit:
  1. Hospital Expert/IV team
  2. Arterial puncture by Rapid Response team (if available)
  3. Notify provider
  4. Peripheral venipuncture
  5. Hospital expert/IV team

Hospital expert/IV team; arterial puncture by Rapid Response team (if available); notify provider; peripheral venipuncture; hospital expert/IV team

  1. Venipuncture on the periphery
  2. Arterial puncture
  3. Unit expert
  4. Arterial line
  5. Hospital expert/IV team
  6. Notify provider

Preparation: Gather the necessary equipment:

  • A tourniquet, a 70% alcohol swab, 2 percent chlorhexidine with a 70% isopropyl alcoholapplicator, aerobic and anaerobic blood culture flasks, and a tourniquet are all required. Vacuette
  • Butterfly set, clean gloves, dressing, pen, and labels are all included.

Preparation of the blood culture bottles includes the following:

  1. Remove the cap from each blood culture vial and use a different alcohol swab to scrape the top of each bottle for 30 seconds
  2. Allow for natural drying.
  • Once the tops have been washed, do not fan or blow on them. Once the tops have been cleansed, do not touch them.

Preparation of the patient

  1. Provide the patient with an explanation of the procedure. Hand hygiene should be practiced. Set up a tourniquet.
  • The tourniquet should not be left on the patient for more than one minute.
  1. Prior to washing the skin, palpate and identify the appropriate place. Take off the tourniquet.

Obtaining the Culture: Collecting the culture with a butterfly set and a vacuette

  1. Assemble the blood culture drawing equipment and make arrangements for the materials that will be required
  2. Hand hygiene should be practiced. Put on a pair of clean gloves
  3. Set up a tourniquet. Apply 2 percent chlorhexidine to the skin using a 70% isopropyl alcohol applicator for 30 seconds, scrubbing the skin from the center outward.
  • Allow for at least 30 seconds of drying time (the skin must be completely dry prior to venipuncture)
  • Once the skin has been washed, avoid using a fan or blowing it. Once the spot has been cleaned, do not palpate it.
  1. Venipuncture should be performed. Butterflyset and vacuette should be used for venipuncture procedures. Completely fill the aerobic bottle first, then the anaerobic bottle (see Appendix A for the proper amount of fluid to use). Fill each bottle with 10mLs at a time until it is full. Keep an eye on the volume because the bottle may overfill. Remove the tourniquet, maintain pressure, and apply the dressing. After removing the gloves, wash your hands thoroughly. While at the patient’s bedside, label cultures with a bedside labeling equipment or handwrite the site of draw on the label with a pen. (See Appendix B for more information.) Send to the lab in accordance with operational unit guidelines

When should blood be obtained from a vascular access device (VAD)? Blood should not be drawn from a VAD unless it is thought that the patient has line-related sepsis. Confirm that the doctor’s order for a blood culture specifies that a line draw be performed. It is more probable that blood cultures collected from lines may be contaminated; consequently, proper care should be taken to prevent contamination. In the case of drawing a blood culture from a VAD, it should always be followed by drawing a blood culture from a peripheral location.

Follow the directions for bottle preparation and blood culture volume volume as given in the preceding section.

Without the use of an adaptor, it is not possible to draw straight from the bottle.

If it is not possible to get a peripheral blood culture and a culture from an IV line must be performed, the following procedures must be followed for obtaining bloodcultures from peripheral IVs, central lines, and PICCs:

  1. Dispose of the needleless connection and replace it with a fresh, sanitary one.
  • Squeeze out the excess alcohol from the hub for at least 30 seconds and let it to dry
  1. Because the bottle cannot be pulled straight from the site, please contact the lab for any extra adapters. Take no more than one set from this access at any given time. If a second set is required, wait 15 minutes before changing the unnecessary connection and repeating the operation.

The number of blood cultures taken and when they are taken are important considerations.

Condition Recommendations
Suspected acute primarybacteremia or fungemia, meningitis, osteomyelitis, arthritis, or pneumonia Obtain 2 sets at the sametime by separate venipuncture immediately following the clinical events thatprecipitate the blood culture.
Fever of unknown origin Obtain 2 to 3 blood culturesets initially at the same time by separate venipuncture.Then, 24 to 36hours later, obtain two more sets of cultures immediately before the expected(usually afternoon) temperature elevation.
Suspected bacteremia or fungemiawith persistently negative blood cultures Consider alternative bloodculture methods designed to recover rare or fastidious microorganisms (e.g.Isolator tube)
Infective endocarditis Obtain 4 blood culture setsduring the first 1-2 hours of evaluation.If all are negative 24 hourslater, obtain 4 more sets.From patients who have received antimicrobialagents within 2 weeks prior to admission, obtain two separate blood cultures oneach of three successive days.Request extended incubation if Brucellaor Bartonella is suspected.
Transport to the Lab Pneumatic tube: To send blood culture bottles by pneumatic tube,place each bottle in a biohazard bag.Seal the bags and place therequisition slips (if not preordered) in the outside pocket of one of the bags.Place the bottles in the carrier so that the bottoms of the bottles are end toend in the center of the carrier and the necks of the bottles face outward.Other specimen tubes may be placed in the carrier with the blood culturebottles as room permits.Regular courier: Use two specimen bags.Wrap one bottlesnuggly with a plastic specimen transport bag and insert the wrapped bottle inanother plastic transport bag. Place the second bottle of the set in thebag.Seal the bag and place requisition slips (if not pre-ordered) in theoutside pocket. Instructions for local laboratory sending blood cultures to CoreMicrobiology laboratory If there is no scheduled courier within 4 hours of blood culturereceipt in the laboratory, contact A1 cab for transport to core laboratory.This may require calling A1 cab more than once per day for blood culturesparticularly during large gaps between scheduled courier runs. Use of A1 cabfor specimen transport can be minimized by strategically scheduling A1 use(example: schedule A1 cab to arrive in the middle of an 8 hour gap betweenscheduled courier runs). If A1 is contacted to pickup blood culture specimens,any additional microbiology specimens pending transport should also be sentalong with batch list. Reference(s)/Source(s): ClinicalKey “Blood specimen collection: Blood cultures” accessed 7/12/18.WiggersJB, Xiong W, Daneman N. Sending repeat cultures: is there a role in themanagement of bacteremic episodes? (SCRIBE study). BMC infectious diseases.2016 Dec; 16(1):286. WilsonML, Mitchell M, Morris AJ, Murray PR, Reimer LG, Reller LB, Towns M, WeinsteinMP, Wellstood SA, Dunne JW, Jerris RC. Principles and procedures for bloodcultures; approved guideline. CLSI document M47-A. Clinical and LaboratoryStandards Institute, Wayne, PA. 2007.

Blood Sample Contamination Fast Facts

How many blood cultures should be taken and when should they be taken are important considerations.

Blood Culture

Test Name Blood CultureAerobic/Anaerobic
Alternate Name(s) (Information Unavailable)
Laboratory Module Microbiology
Ordering Mnemonic CBL
Specimen Type BLOOD CULTURE SETS Two sets of blood culturesfrom separate venipuncture sites, drawn within a 24 hour period and prior to antibiotic therapy, are recommended. If endocarditis is suspected, collect a third set. Venipunctures at least 30 minutes apart is the preferred method.Adult sets -consists of 1 aerobic bottle with a green flip cap and 1 anaerobic bottle with a orange cap. Second set consists of one aerobic bottle.(3 bottles in total).Pediatric collection -consists of a single bottle that has a yellow cap. Two bottles should be collected. ** See note below**Check the expiry date, on the container prior to use. There is a growth sensor in the bottom of the bottle. The sensor should be olive green, this also should visually be inspected prior to use.Gradations on the side of the bottle may help to measure volume of blood being introduced.IMPORTANT Bottles for adults should be inoculated with 8 to 10 mL per bottle. *Caution* – there is a strong draw on these bottles. DO NOT EXCEED the maximum 10 mL per bottle.Pediatric bottles should be inoculated with 2 to 4 mL.**Although the optimal conditions indicated above comply with best practice and manufacturer guidelines, it is recognized that with premature babies and other newborns it may not always be possible to perform more than one collection. In this case, it is imperative that the one bottle collected has the required minimum volume of 2 ml as the incidence of false negative results is high with the low volume collection***In any venipunture the blood cultures are always the first collected.
Collection Container Blood Culture Bottles(also known as BacT/Alert bottles)
Container Information AerobicAnaerobic Paediatric
Collection Information Blood can be collected by venipuncture or intavascular cathetersSite selection – Select a different site for each culture drawn.Avoiddrawing blood through indwelling catheters unless blood cannot be obtained by venipuncture or if diagnosis of catheter sepsis is suspected. (Do not palpate the vein without gloves on)Wash hands and don gloves.Apply tourniquet.Site Preparation – select vein appropriate for venipuncture. After selection has been made, remove tourniquet and cleanse the venipuncture site with the 0.5% chlorhexidine-70% isopropyl combination swab in a circular motion from the center of the puncture site outward covering a circular area of 1 1/2 to 2 inches in diameter for a minimum of 30 seconds. Allow to air dry and do not touch after cleansing.Culture Bottle Preparation – Flip cap off. Clean rubber septum with 70% alcohol. Allow to dry.Indicate on the blood culture label 10ml mark from the level of the media in each bottle prior to attempting collection. Blood will then be collected to this line.Clean tops of any other tubes to be collected.Vacutainer Collection – This method is preferable for adults.Perform venipuncture and collect vacutainer specimens for other tests first using adapter cuff. Use of insert is optional. Collect blood culture bottles. Inoculate aerobic bottle first so as not to introduce air into the anaerobic bottle which is inoculated second.Butterfly Needle Set – Preparation of site and bottles is the same as for vacutainer collection. Collect blood culture bottles.Needle/Syringe System – This method is preferred for children. Preparation of site and bottles is the same as for vacutainer collection. Collect blood in syringe, change needles and inject up to the pre-marked lines on the bottles. Inoculate aerobic bottle first so as not to introduce air.Gently mix bottles to avoid clotting.Labeling – Both blood culture bottles in the set must have the same collection number. Affix one large collection label to each of the bottles in the space provided. Do not cover the bottle bar code. Send all remaining labels in the specimen bag with the blood culture set.Initial the barcode labels and affix to bottles. Indicate the time of collection on the lead label.Apply band aid to venipuncture site.Dispose of any collection system needles in accordance with standard precautions. Adapter cuffs and inserts are not disposable. Clean and sterilize these by disinfecting in bleach.Remove gloves and wash/disinfect hands between each patient.Transport to laboratory promptly.Second set to be collected 30 minutes later.
Test Schedule Daily
Routine Turnaround Time Preliminary: 48 hours Final: 5 days
Stat Turnaround Time Preliminary: 48 hours Final: 5 days
Reference Interval (Information Unavailable)
Critical Values Positives are reported to designated health care provider upon detection.Cultures are incubated for 5 days.
Lab Process Notes The blood culture instrument used for detection of bacterial growth monitors the samples once every 10 minutes. Gram stain will be performed when growth is indicated.Recovery of organisms depends mainly on volume of blood collected and frequency of collection. Blood cultures should be collected prior to antimicrobial therapy.A single set should be discouraged as it is difficult to interpret results.When drawing simultaneously from an indwelling cather/PICC and a peripheral site. A complete set is draw from the line (1 aerobic bottle with a green flip cap and 1 anaerobic bottle with a orange cap) and a single aerobic bottle is drawn from the peripheral site.
Storage and Transport The specimens should be transported as soon as possible to the lab.
Test Referred To On site, BGH laboratory

Blood Culture Bottles

At the Alfred ICU in Melbourne, Chris works as an intensive care physician and ECMO expert. He is also the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health, as well as a Clinical Adjunct Associate Professor at Monash University’s School of Clinical Medicine. The Australia and New Zealand Clinician Educator Network (ANZCEN) was founded by him, and he is currently serving as the Program Director for the ANZCEN Clinician Educator Incubator Program. He serves on the Board of Directors for the Intensive Care Foundation and as a First Part Examiner for the College of Intensive Care Medicine.

CliniEducator.com describes him as “an globally recognized clinician educator who is passionate about assisting clinicians in their learning as well as enhancing the clinical performance of individuals and groups.” His post-graduate studies took him to Australia’s Northern Territory, Perth, and Melbourne after completing his medical degree at the University of Auckland.

Aside from his fellowship training in both critical care medicine and emergency medicine, he has done post-graduate studies in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

In his current position at Alfred Health, he is actively involved in the use of translational simulation to enhance patient care as well as the design of procedures and systems.

He is the creator of the ‘Critically Ill Airway’ course and has taught on a variety of courses all across the world.

His greatest accomplishment is that he is the father of two extraordinary children. @precordialthump is his Twitter handle.|INTENSIVE|RAGE|Resuscitology|SMACC is his Facebook page.

Blood Culture Collection – OSCE Guide

At the Alfred ICU in Melbourne, Chris works as an intensivist and ECMO expert. His other roles include serving as the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health and Clinical Adjunct Associate Professor at Monash University’s Faculty of Medicine. The Australian and New Zealand Clinician Educator Network (ANZCEN) was founded by him, and he is currently serving as the Program Director for the ANZCEN Clinician Educator Incubator Program. As a member of the Intensive Care Foundation’s Board of Directors, he also serves as a First Part Examiner for the College of Intensive Care Medicine’s First Part Examining Board.

  • He has now returned to New Zealand to continue his work.
  • He is a member of the American College of Emergency Physicians.
  • The Alfred ICU’s teaching and simulation programs are coordinated by him, and he is also in charge of the unit’s educational website, INTERACTIVE.
  • He is a co-founder of the FOAMmovement (Free Open-Access Medical Education) and the co-creator of litfl.com, theRAGE podcast, theResuscitologycourse, and theSMACCconference, among other things.
  • @precordialthump is his Twitter handle.|INTENSIVE|RAGE|Resuscitology|SMACC is his Instagram handle.

Gather and prepare equipment

At the Alfred ICU in Melbourne, Chris works as an intensivist and ECMO expert. He is also the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health, as well as a Clinical Adjunct Associate Professor at Monash University. The Australia and New Zealand Clinician Educator Network (ANZCEN) was founded by him, and he is currently serving as the Program Director for the ANZCEN Clinician Educator Incubator program. As a member of the Intensive Care Foundation’s Board of Directors, he also serves as a First Part Examiner for the College of Intensive Care Medicine.

Following completion of his medical degree at the University of Auckland, he went on to do post-graduate study in New Zealand as well as the Northern Territory, Perth, and Melbourne in Australia.

At Alfred Health, he is actively involved in the use of translational simulation to enhance patient care as well as the design of procedures and systems.

He developed the ‘Critically Ill Airway’ course and has taught on a variety of courses all around the world.

His greatest accomplishment is being the father of two wonderful children. @precordialthump is his Twitter handle. |INTENSIVE|RAGE|Resuscitology|SMACC is his Facebook page.

  • Tourniquet (single use)
  • Blood sampling instrument with blood culture bottle adapter (e.g. winged blood collection set)
  • Apron
  • Non-sterile gloves
  • Tourniquet (single use)
  • A pair of blood culture bottles (one for anaerobic culture and one for aerobic culture): Sharps container
  • Cleaning swab x 3 (2 percent chlorhexidine in 70% isopropyl alcohol)
  • Sterile gauze
  • Sterile plaster
  • Tape
  • Laboratory forms, labels, and transportation bag
  • Sharps container

Removal of extraneous packing and assembly of equipment while employing aseptic non-touch technique (ANTT) before to placement in the process tray are recommended:

  • Glue the needle to the barrel (some blood collection systems are already pre-assembled). Then, using a cleaning swab (2 percent chlorhexidine in 70 percent isopropyl alcohol), wipe the tops of each blood culture bottle and allow them to dry before starting with the bottle inoculation procedure.

Introduction

Hands should be washed with alcohol gel. Soap and water should be used to clean your hands if they are visibly stained. Put on personal protective equipment (PPE). Introduce yourself to the patient, stating your name and your position in the situation. Confirm the patient’s name and date of birth with the patient. Give a brief explanation of what the process will entail in patient-friendly language: “Today I need to obtain a blood sample, which will require putting a little needle into a vein in your arm.” As the needle is placed, you may feel a sharp scrape for a limited period of time.” Obtain permission before proceeding with the blood culture collection.

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Place the patient in a comfortable position so that they may relax.

Before proceeding with the clinical process, inquire as to if the patient is experiencing any discomfort.

Choosing an arm

1. Select an arm on which to perform venepuncture:

  • You should inquire as to whether the patient has a choice. Pre-existing medical disorders (e.g., an arterio-venous fistula, lymphoedema, or a stroke that affects the mobility of a limb) may make it impossible to utilize some limbs. It is not recommended to perform venepuncture on an arm that is already receiving an intravenous infusion since the sample may be contaminated.

Choosing a vein

Identify an acceptable venepuncture site on the patient’s arm by doing the following examination:

  • Venepuncture is most usually performed through the median cubital vein in the antecubital fossa. Exclusions should be made from areas of broken, bruised, or erythematous skin Areas where two veins come together should be avoided if at all feasible since valves are frequently present

2.Assess the patient’s arm and arrange it in a comfortable extended posture that allows appropriate access to the targeted venepuncture location. Install the tourniquet about 4-5 finger widths above the anticipated venepuncture location. 4.Palpate the vein you’ve discovered to see if it’s a good candidate for surgery:

  • Making the vein more visible and palpable by tapping it and encouraging the patient to clench their fist repeatedly will help you find the vein more easily. A healthy vein has a’springy’ sensation about it. An inflamed or sclerosed vein should be avoided, as should a vein that feels hard
  • A vein that feels hard should be avoided

Using a finger to tap on the vein and urging the patient to clench their fist repeatedly might make the vein easier to see and palpate. “Springy” describes the sensation of a healthy vein. A vein that feels hard is likely to be sclerosed, thrombosed, or phlebitic (inflamed), and it should be avoided at all costs.

  • Disinfect the patient’s skin using a solution of 2 percent chlorhexidine in 70 percent isopropyl alcohol and allow it to dry
  • The patient’s skin should be cleaned with soap and water when visible stains are present. Once the skin has been cleansed, you should avoid touching the area again (even if you are wearing gloves).

Insertion of the needle

1.Re-apply the tourniquet if it was previously removed. 2. 2.Take the needle out of its sheath. 3.Using your non-dominant hand, gently tug on the skin distal to the insertion site in order to anchor the vein from below. 4.Inform the patient that they will be scratched with a sharp object. Using the bevel pointing upwards, insert the needle into the skin at a 30-degree angle or less, depending on the skin type. As the needle penetrates the vein, you should witness flashback into the needle’s chamber and feel a dramatic lessening in resistance as the needle passes through the vein.

Use the butterfly needle’s wings to lower and secure the needle to the patient’s skin, as shown in Figure 7.

9.

Keep the needle anchored to the skin while you carefully draw and twist the first bottle out of the barrel, making sure to keep it there throughout the process.

The tourniquet should be released at this point.

Request that the patient retain the gauze or cotton wool in place while you dispose of the needle in a sharps container. Dress the patient’s arm with an adhesive bandage (e.g. cotton wool, gauze, plaster). 14.Dispose of the used equipment in the suitable clinical waste container.

To complete the procedure…

Explain to the patient that the treatment is now complete and that they should seek medical attention if the venepuncture site becomes uncomfortable or inflamed during the recovery period. Please express gratitude to the patient for their time. Document the patient’s information on the blood sample vials that are kept at the bedside (using either pre-printed or handwritten labels). Dispose of personal protective equipment (PPE) properly and wash your hands. Provide blood samples to the laboratory for testing in an acceptable plastic bag that is leak-proof, together with the completed laboratory request form.

  • The reason for the sample
  • The time and date of the sample
  • The location where the sample was acquired
  • Your name, signature, and contact information are required.

Reviewer

  1. Why did you choose this sample? When the sample was taken and when it was taken
  2. The location from where the sample was taken You must include your full name, signature and contact information.

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