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comparison of the time it takes to achieve a positive result from both central and peripheral cultures is recommended (Catton et al. 2005). If a culture from the CVAD is positive much earlier than from the peripheral culture (>2 hours earlier) then it can be assumed that the vascular access device is the source of the infection with up to 96% sensitivity and 92% specificity (Bouza et al. 2005). Results of such analysis can guide whether removal of the CVAD is indicated.

Procedure guideline 11.2 Blood cultures: peripheral (winged device collection method)

Essential equipment

Alcohol-based skin cleaning preparation (2% chlorhexidine in 70% isopropyl alcohol)

Alcohol-based swab for blood culture bottle decontamination (2% chlorhexidine in 70% isopropyl alcohol)

A set of blood culture bottles (anaerobic and aerobic)

Vacuum-assisted collection system (winged device for peripheral cultures)

Non-sterile gloves

Gauze swabs

Appropriate document/form

Preprocedure

Action Rationale

1 Explain and discuss the procedure with the patient. To ensure the patient understands the procedure and gives valid consent (NMC 2008b, C).

2 Wash hands with bactericidal soap and water, or decontaminate physically clean hands with alcohol-based handrub. Apply gloves. To reduce the risk of cross-infection and specimen contamination (DH 2007a, C).

3 Clean any visible soiled skin on the patient with soap and water then dry. To reduce the risk of contamination (DH 2007a, C).

Procedure

4 Apply a disposable tourniquet and palpate to identify vein. In preparation for venepuncture. E

5 Clean skin with a 2% chlorhexidine in 70% isopropyl alcohol swab for 30 seconds and allow to dry for 30 seconds. Do not palpate site again after cleaning. To enable adequate skin antisepsis and decontamination, and to prevent contamination from practitioner’s fingers (DH 2007a, C; Inwood 2007, C).

6 Remove flip-off caps from culture bottles and clean with 2% chlorhexidine in 70% isopropyl alcohol swab and allow to dry. To reduce the risk of environmental contamination causing false-positive results (DH 2007a, C).

7 Wash and dry hands again or use alcohol handrub and apply clean examination gloves (sterile gloves are not essential). To decontaminate hands having been in contact with the patient’s skin to palpate vein. E

8 Attach winged blood collection set into the appropriate vacuum holder for taking blood cultures. Remove sheath-covering needle at wings and perform venepuncture. Reduces risk of contamination and health and safety risk to practitioner (DH 2006, C; DH 2007a, C).

9 If blood is being taken for other tests, collect the blood culture first. Inoculate the aerobic culture first. To reduce the risk of contamination of culture bottles after inoculating other blood bottles. E

10 Place adaptor case over blood culture bottle and puncture septum. To initiate vacuum collection action. E

11 Attach aerobic bottle, hold upright, and use bottle graduation lines to accurately gauge sample volumes (at least 10 mL in each bottle or as recommended by manufacturer). Remove bottle and replace with anaerobic bottle. To reduce the risk of a false-negative result due to insufficient volume or overdiluted culture medium (Higgins 2007, C).

12 Remove winged device, apply pressure to the venepuncture site and apply appropriate dressing. To prevent bleeding at the site. E

Postprocedure

13 Discard winged collection set in sharps container. To reduce risk of sharps injury. E

14 Remove gloves and wash/decontaminate hands. To ensure correct clinical waste management and reduce risk of cross-infection (DH 2006, C).

15 Label bottles with appropriate patient details, ensuring the barcodes on the bottles are not covered or removed. To ensure correct patient and sample identity and to aid traceability within the laboratory. E

16 Complete microbiology request form (including relevant information such as indications, site and time of culture). To maintain accurate records and provide accurate information for laboratory analysis (NMC 2009, Weston 2008).

17 Arrange prompt delivery