Blood Culture - Pediatric
Epic Lab Code: LAB7646
Downtime Form: A-1a Doctor-Provider Orders - Pathology Microbiology
BT 6004
Bacteriology/Virology Section
Specimen Instructions:
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.
Collection Medium:
Aerobic Blood Culture Bottle Anaerobic Blood Culture Bottle
Testing Schedule:
24 hrs/day, 7 days a week, including holidays.
Turn Around Time:
Cultures are monitored continuously for 5 days.
Department of Pathology Policies and Procedures:
Blood Culture Collection Procedure, PHL-6
Pediatric Blood Volume Guidelines, PHL-12
Automated, continuous monitoring.