Myco/F Lytic vials are not routinely used for blood culture as 
routine blood cultures are effective for most pathogens.  Yield of 
culture is critically affected by the volume of blood drawn: at 
minimum, THREE bottles from 2 venipunctures and ideally SIX bottles 
from 3 venipunctures should be obtained.  Each bottle should be filled 
with 5 mL of blood.  Bottles are available from the Microbiology 
laboratory (356-2591).

The following guidelines were developed specifically for the diagnosis 
of M. chimaera endovascular infection, where bacterial loads are 
likely high.

1. Order one "AFB Blood Culture R/O Mycobacterium chimaera" in
   EPIC for each venipuncture (LAB8454).  Obtain Myco/F Lytic Bottles
   from the Microbiology Lab.

2. Follow instructions in Nursing policy N-03.020 Blood Culture
   Collection, Adult or PHL-06 Phlebotomy protocol for antisepsis and
   drawing blood.

3. ADULTS with suspected mycobacterial endocarditis:
   collect 2 venipunctures (2 orders total) with 2 bottles per
   venipuncture site (4 bottles total, 5 mL per bottle).
   Minimum 3 full (5 mL) bottles, and up to 6 bottles (from
   3 venipunctures).

   PEDIATRIC patients with suspected mycobacterial
   endocarditis: obtain 2 venipunctures.  For each venipuncture,
   consult the table below for recommended blood volume.
   For volumes less than 5 mL, use one bottle.  For
   volumes greater than 5 mL, split between two bottles.
    -----------------------------------------------------------
         AGE (years)        Volume per Venipuncture (mL)
              1                          2 
              2                          3
              3                          5
              4                          6  
              5                          8
              6                          9
         7 and above             AS ADULT; 10 mL        
    -----------------------------------------------------------

4. Inoculate no more than 5 mL of blood into each Myco/F Lytic bottle.
   Do NOT overfill.

5. Send to Microbiology laboratory; call 356-2591 with questions.