Procedure: Blood Culture Sampling

Casebank Combined
1

Who you are:
You are FY2 in Surgery Department

Who the patient is:
Tom Henderson, 35-year-old male has had an appendectomy 3 days ago. He has now developed a fever.

Other information
Your consultant has asked you to take a blood culture sample from the patient

What you must do:
Take focused history, do the relevant procedure, and address the patient’s concerns

History Taking:

  • Start the station well (I can see from my notes that you have been admitted here for an operation to remove your appendix 3 days ago)
  • IPS:
    – Pick up on non-verbal cues (if the patient is in pain or looking unwell)
    – Build Rapport. Ask about the hospital stay.
  • Why? & Why?
    – My consultant has asked me to take a blood sample from you to send it for culture to test for the specific bug causing your symptoms.
  • Take focused History relevant only to your procedure
    – Ask about any bleeding, pain, or discharge from the operation site.
    – Ask about bowel motion since after the operation.
  • Red Flags - features of sepsis (confusion, urine output. etc.)
  • MMA
    – Medical Conditions (specify any bleeding disorder) - Medications (specify any blood thinner)

Patient preparation:

Patient:

  • Benefit ( I would like to take a blood sample from you in order to know the bacteria
  • Risk: It should not be painful, but if you feel uncomfortable at any time let me know.
  • Explain: explain exactly what you are going to do: (I will be inserting a thin needle into one of the blood vessels (veins/ arteries) of your (forearm/ wrist).
  • It will feel like a sharp scratch, but I will be as quick and gentle as possible

Doctor:

  • Position : Can you please straighten your elbow/ wrist for me.
  • Exposure: Can you please roll up your sleeves for me.
  • Please be observant. (Notice whether the patient has short sleeves, or has rolled up the sleeves already, and comment on it accordingly).

Both:

  • Privacy: I will ensure your privacy.
  • Chaperon: Blood procedures do not require a chaperone.
  • Consent: Do I have your consent to proceed.
  • Ask about any arm soreness and any arm preference.
  • Do not forget to inform the patient that if you fail, you may need to repeat the procedure.

Procedure:

Remember to be extra-clean

  • Collect your equipment:
    – Tourniquet
    – Alcohol swab
    – Vacutainer and needle
    – Blood culture bottles
    – 2 (2% Chlorhexidine 70% ispropyl) alcohol wipes
    – Cotton piece.
  • Prepare your equipment in your clean area, then put them on your tray:
    – Partially open the alcohol swabs
    – Remove the grey (white) cap from the needle and discard it. Then attach the needle to the vacutainer.
    – Loosen up the other cap (The green cap) slightly and keep it aside ready for the procedure.
    – Culture Bottles: Check the expiry date
    – Flip off the caps
    – Clean the tops of the bottles each with a different chlorhexidine wipes
  • Gloves: Assume you are wearing gloves
  • Feel the vein
  • Torniquet (Tie the torniquet above the cubital fossa)
  • Clean Prick Collect
    – Clean the area with one single stroke
    – Remove the green cap to reveal the needle, and discard the cap.
    – Then warn the patient and prick with the bevel pointing up.
    – Keep the needle fixed and secure all the time.
    – Loosen the tourniquet as soon as you see the flashback.
    – Once in the vein, while holding the vacutainer holder firm and still with your left hand, attach the vacutainer and let it fill.
    – Once blood is collected, swirl the bottles 180 degrees and put them on the tray.
  • Cotton and Label
    – Withdraw the needle carefully. Once the needle is out, press the cotton down on the puncture site.
    – Dispose the needle attached to the vacutainer holder into the sharps bin.
    – Verbalize labeling the sample with the patient’s details and verbalize sending it to the lab.

Management :

  • Sit down and discuss with the patient the management outline:
  • Keep in the observation unit
  • Monitor Urine output
  • Treatment
    – PCM for the fever
    – Start on Broad Spectrum Antibiotic and change it once the results of the culture come back.

Safety net

  • about the procedure itself (any bleeding, swelling or soreness)
  • about the patient’s general condition (Tummy pain, discharge, bleeding from the operation site, constipation, if fever does not resolve…)
5 Likes
2

Blood culture scenario new on as per Dr Loovan

The patient has previous visit for cellulitis treated with fuclloxacin

Current situation:
Test blood cultures shows infection in the blood

Treatment :
Ask the Patient for followup
Senior
Report suspected resistance , means the antibiotic is not working and we need to give new antibiotics, We will discuss with seniors and tell you about the medicine
Dont write any new antibiotics

Gram positive cocci in the results means its some bug like staphylococci , we are still waiting for the sensitivity test . According to what is responding we will write antibiotic .

She will refuse for admission , tell her about septicemia , life threatening infections.

Safety Net , leaflet .

Dont panic and you can just manage this way

3

Blood culture new scenario

The patient has previous visit for cellulitis treated with fuclloxacin

Current situation:
Test blood cultures shows infection in the blood

Treatment :
Ask the Patient for followup
Senior
Report suspected resistance , means the antibiotic is not working and we need to give new antibiotics, We will discuss with seniors and tell you about the medicine
Dont write any new antibiotics

Gram positive cocci in the results means its some bug like staphylococci , we are still waiting for the sensitivity test . According to what is responding we will write antibiotic .

She will refuse for admission , tell her about septicemia , life threatening infections.

Safety Net , leaflet .

Dont panic and you can just manage this way