and
Aerobic Blood Culture Bottle		Anaerobic Blood Culture Bottle

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

Cultures are held for 5 days

Automated, continuous monitoring.

Order Information
This order enables diagnosis of a catheter-related bloodstream 
infection through comparison of the differential time to positivity 
between cultures drawn from a central line and a venipuncture.  
Because bacterial load is highest at the origin of the infection (the 
catheter), a definitive diagnosis of CRBSI is made when identical 
organisms are recovered from the catheter and peripheral cultures and 
the catheter culture is positive greater than or equal to 2 hours 
earlier than the peripheral culture.  This "differential time to 
positivity" can be calculated from the time to positivity reported for 
each set in Epic.

In diagnosing a catheter-related bloodstream infection (CRBSI) 
multiple sets of bottles and a peripheral venipuncture are REQUIRED.  
For a single draw from a catheter without a venipuncture please use: 
BLOOD CULTURE - ADULT instead.

Recommendations
[1] Fill bottles with equal volumes so that differential time to 
positivity is accurately calculated.

[2] Volume of blood cultured is the primary determinant of whether 
bloodstream infection is detected.  For suspected CRBSI, a minimum of 
2 sets of bottles should be sent before initiation of antimicrobial 
therapy and the bottles should be appropriately marked to reflect the 
site from which the samples were obtained.  For this order, two 
venipunctures and one sample drawn through any lumen of a catheter are 
ideal.

[3] If no blood sample can be drawn from a venipuncture it is 
recommended that at least 2 sets should be drawn through different 
catheter lumens.  In this case, check the boxes next to the "site #1, 
catheter" and "site #4, catheter" orders and fill in the source 
(e.g. "red lumen" or "PICC") for each in the individual orders that 
result.  If a venipuncture cannot be obtained for what was intended to 
be a catheter draw, the documented source (catheter) will override the 
source on the initial order (venipuncture).

General Recommendations
[1] For procedures, refer to Nursing Policy & Procedure (N-03.020).

[2] To maximize volume, use the phlebotomy protocols listed under 
Reference Links.

[3] If molds, Blastomyces, Histoplasma, Nocardia, or Malassezia spp. 
are suspected, 3 orders (ideally) should be placed for Microbiology: 
Fungus Blood Culture as these organisms are not detected well by 
typical blood culture.  For Malassezia, which is sometimes associated 
with catheters used for CVN/TPN, specify (free text) that this fungus 
is under consideration so specific cultures are set up.  For detection 
of Candida catheter-associated bloodstream infection a fungal culture 
is unnecessary and inefficient: instead, draw the volume above and 
inoculate into two aerobic bottles (no anaerobic bottles).

Room Temperature.
Label with patient identifiers and site of draw.

Protect specimen by wrapping in bubble-wrap or toweling.
Blood - Do not freeze, ship at room temperature. Ship express mail with overnight delivery.