![]() ![]() Line removal is generally required (including tunneled catheters). Staph aureus and yeast can be difficult to eradicate. Staph aureus in the blood is associated with endocarditis. This should Ideally occur prior to antimicrobial therapy initiation but should not delay treatment. Many patients are admitted with sepsis as a differential diagnosis prompt cultures are indicated. Ophthalmology consult is usually indicated to rule out intraocular involvement when yeast is isolated in blood. Endocarditis should be ruled-out for some blood stream infections (e.g., staph aureus).Review need for repeat cultures with physician. Patients who have blood cultures that are positive for staph aureous (either resistant or sensitive SA) or yeast should have blood cultures repeated ~every 2 days until the cultures are negative.Review need for empiric antimicrobials with physician. Patients undergoing hypothermia protocol with temperature persistently above target should be cultured.Cultures should be repeated if a patient has had a previous positive culture with uncertain significance (e.g., possible contamination or following removal of a line with a positive culture where treatment was not initiated). ![]() Review indications for pan cultures for all new admissions.Verify that there is an order (communication order) or an indication supported by Medical Directive.Quick orders for blood cultures are for "nurse to order cultures" or "nurse to pan culture". This should include the date of insertion, the location of insertion (e.g., R IJ) and type of catheter (e.g., specify whether the central line is a PICC or dialysis line). If a physician enters an order for blood cultures (and this information has not been entered with the order), cancel the blood culture order should be cancelled and re-entered with the necessary information. This information cannot be entered once the order has been placed. In CCTC, all blood culture orders should be entered by a nurse to facilitate the entry of details about the line insertion. Ideally, blood cultures for patients with indwelling intravascular lines should include one venipuncture plus any indwelling line cultures. If a physician orders a single blood culture, the nurse is authorized to obtain a second set. Nurses are accountable to ensure that cultures are drawn as per protocol. Do not draw two sets of cultures from the same draw (as this would still be a single draw specimen and lead to misinterpretation of results). In the rare event that cultures can only be obtained from a single draw or site, the reason for the single draw should be documented. The purpose of drawing 2 or more cultures is to increase the sampling yield and to help to rule out contamination. Line details must be entered at the time the orders are placed. Be sure to specify the type of central line. triple lumen, arterial line, PICC, HD catheter), the site (e.g., right IJ) and the date of insertion. ![]() Line details should include the type of intravascular device (e.g. RNs carry a medical directive to order cultures when indicated. Each set of cultures should be drawn from a different draw (e.g., 2 different venipuncture sites or a venipuncture plus line site(s). Request Catheter Associated Bacteremia EvaluationĪny order for blood cultures should consist of a MINIMUM of 2 complete sets of cultures.Identify Number of Samples to be Collected.Ensure that patient and health care provider safety standards are met during this procedure including: ![]()
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