Blood Culture Panel - Peds Catheter Associated
Epic Lab Code: O104801
Downtime Form: A-1a Clinical Microbiology Laboratory Requisition
Microbiology
BT 6004
356-2591
Bacteriology/Virology Section
Specimen Instructions:
In diagnosing a catheter-related bloodstream infection (CRBSI) multiple sets of bottles and a venipuncture are REQUIRED. For a single draw from a catheter without a venipuncture please use Epic order LAB7646: BLOOD CULTURE - PEDIATRIC. 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 including newborn nursery 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 to maximum of 20 mL 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 1) For suspected CRBSI, 2 sets of bottles, with separate sets drawn from the catheter and a venipuncture, should be cultured before initiation of antimicrobial therapy, and the bottles should be appropriately marked to reflect the site from which the samples were obtained. Fill bottles with equal volumes. 2) If a blood sample cannot be drawn from a venipuncture, it is recommended that at least 2 blood samples 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. Fill bottles with equal volumes. 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). 3) A definitive diagnosis of CRBSI is made when identical organisms are recovered from the catheter draw and venipuncture (or second lumen) cultures, and when 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. Catheter Preparation Refer to the Nursing standard of care for the appropriate pediatric service and hardware. 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:
and
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.
Comments:
References
Department of Pathology Policies and Procedures:
Blood Culture Collection Procedure, PHL-6
Pediatric Blood Volume Guidelines, PHL-12

UI Hospitals and Clinics Nursing Policies and Procedures
Blood Culture Collection, Pediatric
Methodology:
Automated, continuous monitoring.
CPT Code:
87040