and
Aerobic Blood Culture Bottle		Anaerobic Blood Culture Bottle

24 hrs/day, 7 days a week, including holidays.

Cultures are monitored continuously for 5 days.

Automated, continuous monitoring.

A single set of blood cultures to detect BSIs is inadequate. See 
Smart Sets to request multiple sets.

A blood culture "set" consists of an aerobic and anaerobic bottle.  To 
detect bacteremia with reasonable certainty, for each set, draw the 
following MINIMUM* volumes of blood and split this volume between two 
bottles as follows:

Prenatal/NICU < 1500g
Draw Volume:                    0.5 mL
Bottles to Inoculate:           Aerobic (blue top, 924171) 

Prenatal/NICU >1500g
Draw Volume:                    0.5-1.0 mL
Bottles to Inoculate:           Aerobic (blue top, 924171)
                              

Up to 1 year
Draw Volume:                    1.0 mL
Bottles to Inoculate:           50%  Aerobic (blue top, 924171)
                                50% Anaerobic (purple top, 924172)

1+ years
Draw Volume:                    1 mL per year of age
Bottles to Inoculate:           50%  Aerobic (blue top, 924171)
                                50% Anaerobic (purple top, 924172)

 *To maximize volume, use the phlebotomy protocols listed below under
  Reference Links. 
**Do not exceed maximum of 2.5% of the estimated blood volume of the
  patient or 10 mL per bottle.  Filling bottles (10 mL each) may be
  appropriate for adult-size children regardless of age.

If molds, Blastomyces, Histoplasma, Nocardia, or Malassezia spp. are 
suspected, order: Microbiology: Fungus Blood Culture (LAB2217) as 
these organisms are not detected well by typical blood culture.  For 
detection of Candida bloodstream infection a fungal culture is 
unnecessary and inefficient, instead, draw the volume above and 
inoculate into two aerobic bottles.

Recommendations
For suspected bloodstream infection (BSI), collect 3 sets (6 bottles) 
prior to antibiotic therapy (except for NICU infants; see table above) 
from separate sites. Ideally, three venipunctures should be performed 
immediately but a third set of bottles can be drawn at a 4-6 hour 
delay without significant loss of yield.

Skin Preparation
1) Clean the site with an alcohol pad, moving in a concentric circle.
   Allow the alcohol to dry.
2) Pediatric: Cleanse skin with ChloraPrep 1.5 mL Frepp Applicator
   (907672) 
NICU: Follow the NICU standard of practice for skin prep.
Open ChloraPrep applicator and squeeze the wings together to release 
the antiseptic.  Do not touch the sponge.  Wet the sponge by 
repeatedly pressing and releasing the sponge against the skin until 
the liquid is visible.  Scrub the site vigorously, with a side to side 
motion, for at least 30 seconds.  Allow the site to air dry for at 
least 30 seconds or until it is completely dry.
   2.1 (Alternate method) If the patient is allergic to chlorhexidine,
       prep site with a 30 second 70% alcohol scrub.  Let the site dry
       and then apply tincture of iodine in a concentric circle,
       starting at the center and let dry.
   2.2 (Alternate method) If the patient is allergic to chlorhexidine
        and iodine, scrub the site vigorously with 70% alcohol for 
        60 seconds and let dry.
3) Consult guidelines above for blood craw and bottle fill volumes.  As
   necessary, remove overcaps from bottles and cleanse each rubber
   septum with separate 70% alcohol swabs.  Allow septum to dry 1 min.
   before inoculating.
4) Draw and inoculate bottles according to the chart above.  Transport
   time <2 h.
5) Label bottles with either Cerner or Epic labels; do not cover the
   bar code label.  Record the time, collection site, and your
   initials.

Label transport tube with two patient identifiers, date and time of collection.
Specimen should be collected and packaged as close to shipping time as possible.

Blood Specimen - Store at ambient or room temperature.
Specimen cannot be frozen.

Place specimen into zip-lock type bag, seal bag.
DO NOT FREEZE, protect specimen by wrapping in bubble-wrap or toweling.
Place requisition into outside pocket of bag.
Recommend early AM overnight shipping or equivalent if not on courier service.

See also:
Blood Culture Panel - Peds Catheter Associated

See Additional Information:
Pediatric Maximum Blood Volume Guidelines