Blood Culture - Pediatric Show
Testing Schedule: 24 hrs/day, 7 days a week, including holidays. Turn Around Time: Cultures are monitored continuously for 5 days. Methodology: Automated, continuous monitoring. Instructions: A single set of blood cultures to detect BSIs is inadequate. See
Smart Sets to request multiple sets.
A blood culture "set" consists of an aerobic and anaerobic bottle. To
detect bacteremia with reasonable certainty, for each set, draw the
following MINIMUM* volumes of blood and split this volume between two
bottles as follows:
Prenatal/NICU < 1500g
Draw Volume: 0.5 mL
Bottles to Inoculate: Aerobic (blue top, 924171)
Prenatal/NICU >1500g
Draw Volume: 0.5-1.0 mL
Bottles to Inoculate: Aerobic (blue top, 924171)
Up to 1 year
Draw Volume: 1.0 mL
Bottles to Inoculate: 50% Aerobic (blue top, 924171)
50% Anaerobic (purple top, 924172)
1+ years
Draw Volume: 1 mL per year of age
Bottles to Inoculate: 50% Aerobic (blue top, 924171)
50% Anaerobic (purple top, 924172)
*To maximize volume, use the phlebotomy protocols listed below under
Reference Links.
**Do not exceed maximum of 2.5% of the estimated blood volume of the
patient or 10 mL per bottle. Filling bottles (10 mL each) may be
appropriate for adult-size children regardless of age.
If molds, Blastomyces, Histoplasma, Nocardia, or Malassezia spp. are
suspected, order: Microbiology: Fungus Blood Culture (LAB2217) as
these organisms are not detected well by typical blood culture. For
detection of Candida bloodstream infection a fungal culture is
unnecessary and inefficient, instead, draw the volume above and
inoculate into two aerobic bottles.
Recommendations
For suspected bloodstream infection (BSI), collect 3 sets (6 bottles)
prior to antibiotic therapy (except for NICU infants; see table above)
from separate sites. Ideally, three venipunctures should be performed
immediately but a third set of bottles can be drawn at a 4-6 hour
delay without significant loss of yield.
Skin Preparation
1) Clean the site with an alcohol pad, moving in a concentric circle.
Allow the alcohol to dry.
2) Pediatric: Cleanse skin with ChloraPrep 1.5 mL Frepp Applicator
(907672)
NICU: Follow the NICU standard of practice for skin prep.
Open ChloraPrep applicator and squeeze the wings together to release
the antiseptic. Do not touch the sponge. Wet the sponge by
repeatedly pressing and releasing the sponge against the skin until
the liquid is visible. Scrub the site vigorously, with a side to side
motion, for at least 30 seconds. Allow the site to air dry for at
least 30 seconds or until it is completely dry.
2.1 (Alternate method) If the patient is allergic to chlorhexidine,
prep site with a 30 second 70% alcohol scrub. Let the site dry
and then apply tincture of iodine in a concentric circle,
starting at the center and let dry.
2.2 (Alternate method) If the patient is allergic to chlorhexidine
and iodine, scrub the site vigorously with 70% alcohol for
60 seconds and let dry.
3) Consult guidelines above for blood craw and bottle fill volumes. As
necessary, remove overcaps from bottles and cleanse each rubber
septum with separate 70% alcohol swabs. Allow septum to dry 1 min.
before inoculating.
4) Draw and inoculate bottles according to the chart above. Transport
time <2 h.
5) Label bottles with either Cerner or Epic labels; do not cover the
bar code label. Record the time, collection site, and your
initials.Sample Processing: Label transport tube with two patient identifiers, date and time of collection. Sample Storage: Blood Specimen - Store at ambient or room temperature. Transport Instructions: Place specimen into zip-lock type bag, seal bag.
 AbstractBackgroundBloodstream infections (BSIs) are a major cause of morbidity and mortality in paediatric patients. For fast and accurate diagnosis, blood culture (BC) is the reference standard. However, the procedure for blood sampling in paediatric patients, particularly the optimal blood volume, is the subject of controversy stemming from a lack of knowledge of the bacterial load and because of several obstacles such as low intravascular volume and the risk of causing anaemia. AimsThe aim of this narrative review is to summarize current knowledge on blood sampling in paediatric patients for BC purposes, in particular blood volume and number and type of BC bottles needed for reasonable future guidelines/recommendations. SourcesA comprehensive literature search of PubMed, including all publications in English, was performed in June 2019 using the search terms ‘blood culture’, ‘blood volume’, ‘bloodstream infection’, ‘diagnostic’, ‘paediatric’ and/or ‘sepsis’. ContentThe amount of inoculated blood determines the sensitivity, specificity and time to positivity of a BC, and low-level bacteraemia (≤10 cfu/mL) in paediatric patients is presumed to be more common than reported. Current approaches for ‘adequate’ blood volume for paediatric BC are mainly weight- or age-dependent. Of these recommendations, the scheme devised by Gaur and colleagues seems most appropriate and calls for a sample of 1–1.5 mL for children weighing <11 kg and 7.5 mL for a patient weight of 11–17 kg to be drawn into one BC bottle. Inclusion of a more detailed grading in the weight range 4–14 kg, as published by Gonsalves and colleagues, might be useful. ImplicationsThis review could be important for future guidelines on paediatric BC collection and thus could contribute to improving patient management and lowering the economic and global health burden associated with BSI. Furthermore, upcoming molecular-based approaches with low sample volumes might be an interesting alternative. KeywordsBlood culture Blood volume Bloodstream infection Diagnostics Neonate Paediatric Sepsis Cited by (0)© 2019 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. How much blood can you draw from an infant?According to research on safe blood draws in infants, it is recommended by several studies and guidelines that the maximum amount of blood drawn from infants and children in 24 hours be between 1% and 5% of the total blood volume (TBV) of the child. Ideally, the amount should be less than 3% of the TBV.
What is the preferred method of collecting blood from infants and neonates?Blood collection from the heel is the standard for newborn screening. The medial and lateral parts of the underfoot are preferred.
What is the maximum amount of a child's blood volume that may be removed over a 1 month period?The TBV of a child is around 75–80 ml/kg and is higher in the neonatal period (from 85 ml/kg it rises to a peak of 105 ml/kg by the end of the first month and then drops progressively over ensuing months). Thus, the TBV of a 3.5-kg 2-week-old will be about 350 ml while that of a 10-kg 15-month-old will be about 800 ml.
What is the preferred method of blood collection in newborns and infants quizlet?What is the preferred method of blood collection in newborns and infants? Dermal puncture. Which of the following tests cannot be collected using a dermal puncture? Blood cultures.
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What is the required specimen amount when collecting a blood culture from an infant?
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