At the completion of the procedure, ensure that all choking hazards (e.g., syringe caps, port caps, adhesive bandages, bits of tape, twist-off caps from saline bullets) are removed from the patient’s linens and placed in the appropriate receptacle.
Don appropriate personal protective equipment (PPE) based on the patient’s signs and symptoms and indications for isolation precautions.
If unable to obtain blood cultures in a timely fashion, do not delay antibiotics.
Blood tests are among the most used diagnostic aids in the care and evaluation of children. Blood tests can yield valuable information about the patient’s nutrition, hematologic, metabolic, immune, and biochemical status.
Blood culture specimens are obtained by venipuncture, which involves inserting a hollow-bore needle into the opening (lumen) of a vein. Specimens can be obtained with a winged infusion set (butterfly needle) (Figure 1) or a standard needle attached to a syringe. Additionally, specimens may be obtained from central lines or arterial lines using sterile technique and following the organization's practice.
Because veins are the major sources of blood for laboratory testing and routes for IV fluid or blood replacement, the nurse must be skilled in venipuncture to avoid injury to veins. When performing venipuncture on a pediatric patient, the nurse should explore a variety of sites for venous access, including the scalp, antecubital fossa, saphenous, hand, and foot veins (Figure 2) (Figure 3). The nurse must have a good understanding of the anatomy, physiology, and physics related to venipuncture.
The procedure is painful, and for many children, just the appearance of a needle is frightening. Using interventions such as distraction, sucrose, topical analgesia, positioning, music, and family involvement significantly decreases a child's anxiety regarding needlesticks.undefined#ref1">1,8 Several topical agents are available to provide analgesia for venipuncture, including creams and vapocoolant sprays.
In infants younger than 3 months of age, sucrose in water has been shown to work as well as lidocaine-prilocaine.8 Oral sucrose is thought to stimulate the release of endorphins that work on opiate receptors.8 For blood cultures, which aid in detecting bacteria in the blood, at least two blood specimens should be drawn from two different sites. Contamination with the patient’s skin flora that is introduced during specimen collection may cause false-positive results. Proper skin preparation can reduce the rate of blood culture contamination. There are conflicting study results regarding the efficacy of one antiseptic over another. When using an antiseptic, the nurse must consider the time needed for it to have its maximum effect and carefully follow the directions for its use. If only one culture produces bacteria, the assumption is that the bacteria are contaminants, rather than infectious agents.
Pediatric culture bottles are usually used for pediatric patients, and the recommended volumes for cultures are usually printed on the bottle by the manufacturer. For pediatric patients, organizations’ practices vary regarding the number of blood cultures that must be drawn and the amount of blood that needs to be obtained. Anaerobic blood cultures may not be ordered on all pediatric patients.
Cultures should be performed before antibiotic therapy begins because the antibiotic may interrupt the organism’s growth in the laboratory. If the patient is receiving antibiotics, the laboratory should be notified about which ones are being used.
A toddler or preschool-age child may fear that the loss of blood is a threat to life, so the nurse should use developmentally appropriate language to explain that blood is continually being made. An adhesive bandage gives a toddler or preschool-age child assurance that blood will not leak out through the puncture site.
For skin preparation, there is insufficient evidence to recommend a single product for all neonates.
Rationale: Drawing minimum volumes decreases the incidence of iatrogenic anemia.
Rationale: Onset of action of these agents requires application before the procedure begins.
Rationale: Obtaining a sample from a cool extremity may be difficult because of vasoconstriction.
Rationale: Holding the patient ensures the position is maintained and the site is not contaminated.
Do not offer a bottle to an infant during the procedure because choking may occur.
If possible, avoid using a tourniquet to reduce the risk of injury to the vascular endothelium. If a tourniquet is required, limit the time of use to reduce the risk of hemolysis and inaccurate laboratory results.
Do not keep the tourniquet on the patient longer than needed.
Rationale: Heat causes local dilation and makes the vein more visible.
Do not touch the site after preparation unless sterile gloves are worn.
Rationale: This technique allows controlled entry into the vein after the skin has been pierced. Entering the skin distal to the vein prevents unanticipated vein puncture, which may result in inadequate blood specimen retrieval and the development of a hematoma.
To avoid false positive results when obtaining blood cultures via a venipuncture, discard a volume of blood, as per organization's practice, before filling the blood culture bottles.6
Rationale: Pressure over the needle can cause discomfort. Careful removal of the needle minimizes discomfort and vein trauma.
Rationale: Air in the tubing will be drawn in along with the blood.
Rationale: The syringe technique prevents air from entering the anaerobic bottle so the anaerobic bottle should be filled first.
If there is only enough blood for one bottle, the aerobic bottle should be filled.
Keep the blood culture bottles upright during the procedure.
Rationale: Bleeding may occur after the vein is punctured if inadequate pressure is applied, particularly in an active patient.
Report persistent active bleeding.
Rationale: Inadvertent arterial puncture may affect perfusion distal to the puncture site.
Report decreased or absent perfusion distal to the puncture site.
Rationale: The patient may require more blood tests in the future. Anxiety or concerns should be expressed and addressed.
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