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To avoid retesting and possible antibiotic overuse, follow these four tips when drawing blood for a suspected case of community-acquired pneumonia.
Efforts to control handling, sterile technique spares patient overmedication
The way you draw blood cultures for community-acquired pneumonia (CAP) patients can have a dramatic impact on your patient's outcome, according to Paula M. Neira, RN, JD, CEN, nurse educator for the Department of Emergency Medicine at The Johns Hopkins Hospital in Baltimore.
If a blood culture obtained in the ED is contaminated, a repeat culture must be drawn and processed. "This means your patient receives multiple antibiotics as providers attempt to find one that works, with the patient enduring the side effects," says Neira. "Once information is obtained from processing the blood cultures, targeted antibiotics can then be administered." Here are practices for blood culture collection used by ED nurses at The Johns Hopkins Hospital to prevent contamination and reduce delays in antibiotic administration:
* Each shift, a specific staff member obtains all ordered blood cultures.
"In our ED, we designate a clinical technician as the 'blood culture tech,' and provide them with a telephone," says Neira. When a blood culture is ordered, the ED nurse calls the tech and informs him or her of the need for a culture collection."It makes obtaining the blood culture a sole-focus priority for someone, rather than being a task that must compete with other priorities," says Neira. "This [having multiple priorities] can lead to cutting corners that increases the potential for contamination."
* Performance is audited daily in real time.
Neira stops the process if sterile technique is broken, and she suggests repositioning a patient's arm to minimize the need for re-palpation of the venipuncture site. "Nurses are reminded that blood culture collection is a sterile procedure that must be done meticulously," says Neira.
* Blood cultures are not routinely drawn from vascular access devices.
This practice significantly increases the risk of contamination, says Neira. "Excluding the routine use of existing IV sites can lower contamination rates by as much as 70%," she says.1 "Limit use of these accesses to obtaining a blood culture only upon insertion, or if for a pre-existing access such as a central line or peripherally inserted central catheter, catheter sepsis is suspected."
* Blood cultures are not routinely collected after antibiotics have been administered in the ED.
"In the event that blood cultures are ordered after antibiotics have been given, authorization should be obtained from department leadership before drawing the specimen," says Neira. "This allows for confirmation that the patient truly needs the culture and that the admission order is documented first in order to comply with the Joint Commission's core measure requirements."
1. Norberg A, Christopher, NC, Ramundo, ML, et al. Contamination rates of blood cultures obtained by dedicated phlebotomy versus intravenous catheter. JAMA 2003; 289:726-729.
This story was adapted from one originally published by AHC Media LLC (800-688-2421).