Unit 6

Question 1

helps determine the presence and extent of infection as well as indicating the type of organism responsible and the antibiotic to which it is most susceptible

Answer 1

Blood culture

Question 2

When are blood cultures typically ordered?

Answer 2

immediately before or after anticipated fever spikes when bacteria are most likely to be present

Question 3

Blood culture examination is requested or performed to detect the causes of?

Answer 3

Fever of unknown origin (FUO)
Bacteremia – bacteria in the blood
Septicemia – microorganisms or their toxins in the blood
Fungemia – fungi or yeasts in the blood

Question 4

T/F:
Blood is collected prior to the fever peak.

Answer 4

True

Question 5

How many blood cultures are necessary to optimize the detection of bacteremia and fungemia according to American Society for Microbiology (ASM)?

Answer 5

2 to 4 blood cultures

Question 6

For optimum results, blood specimens should be drawn how many minutes apart?

Answer 6

30 to 60 minutes

Question 7

VOLUME OF BLOOD PER CULTURE:
Infants and younger children

Answer 7

1% to 4% of the patient’s total blood volume
(typically 1-2 mL per draw)

Question 8

VOLUME OF BLOOD PER CULTURE:
Adults or people weighing more than 80 pounds

Answer 8

20 to 30 mL per culture with a minimum of 10 mL per draw

Question 9

Blood culture specimens are most commonly collected in special bottles containing _________ _________ (referred to as medium) that encourages the growth of microorganisms.

Answer 9

nutrient broth

Question 10

Specimens are typically collected in special bottles in sets of two, which are?

Answer 10

one aerobic (with air)
one anaerobic (without air)

Question 11

When a syringe is used to collect the blood, which bottle is filled first?

Answer 11

anaerobic bottle

Question 12

When a butterfly is used, which bottle is filled first?

Answer 12

aerobic bottle;
because air in the tubing will be drawn into it along with the blood.

Question 13

A critical part of the blood culture collection procedure

Answer 13

SKIN ANTISEPSIS

Question 14

Skin antisepsis is frequently referred to as?

Answer 14

prepping the skin

Question 15

Why is skin antisepsis performed?

Answer 15

to remove soil and transient microorganisms on the skin

Question 16

T/F:
Failure to carefully disinfect the venipuncture site can introduce skin-surface bacteria into the blood culture bottles and interfere with interpretation of results.

Answer 16

True

Question 17

How many seconds of friction scrub do the collection sites require to get to the bacteria beneath the dead skin cells onto the surface of the arm?

Answer 17

30- to 60-second friction scrub

Question 18

ANTISEPTICS USED TO CLEAN THE SITE OF COLLECTION FOR BLOOD CULTURE

Answer 18

10% povidone iodine
1% to 2% tincture of iodine
Chlorhexidine gluconate
70% ethyl alcohol

Question 19

T/F:
In using a povidone–iodine or chlorhexidine gluconate ampule swab, the swab should be placed above the site of needle insertion and moved inward in concentric circles, going over the area more than once.

Answer 19

False;
AT the site of needle insertion
OUTWARD in concentric circles
WITHOUT going over any area again

Question 20

The area covered should be how many inches in diameter?

Answer 20

3-4 inches

Question 21

Because of the increasing incidence of iodine sensitivities, some healthcare facilities are using this antiseptic preparation in blood culture preparation kits that have a one-step application and are effective with a 30-second scrub.

Answer 21

chlorhexidine gluconate/isopropyl alcohol

Question 22

T/F:
According to the CLSI, chlorhexidine gluconate is the recommended blood culture site disinfectant for infants younger than 2 months and patients with iodine sensitivity.

Answer 22

False;
2 months and older

Question 23

Enumerate the steps in performing blood culture specimen collection

Answer 23

1. Follow normal identification protocol, and explain the collection procedure.
2. Identify venipuncture site, and release the tourniquet.
3. Aseptically select and assemble equipment.
4. Perform friction scrub.
5. Allow air site to dry.
6. Remove the flip off cap and inspect the bottle for defects.
7. Cleanse the culture bottle stoppers while the venipuncture site is drying.
8. Mark the minimum and maximum fill on the culture bottles.
9. Reapply the tourniquet and perform the venipuncture without touching or repalpating the site.
10. Inoculate the medium as required.
11. Invert the bottle several times.
12. Clean the patient’s skin if applicable.
13. Label the specimen with patient details.
14. Dispose of used and contaminated materials.
15. Thank the patient, remove gloves, and sanitize hands.
16. Transport specimens to the lab as quickly as possible.

Question 23

Enumerate the steps in performing blood culture specimen collection

Answer 23

1. Follow normal identification protocol, and explain the collection procedure.
2. Identify venipuncture site, and release the tourniquet.
3. Aseptically select and assemble equipment.
4. Perform friction scrub.
5. Allow air site to dry.
6. Remove the flip off cap and inspect the bottle for defects.
7. Cleanse the culture bottle stoppers while the venipuncture site is drying.
8. Mark the minimum and maximum fill on the culture bottles.
9. Reapply the tourniquet and perform the venipuncture without touching or repalpating the site.
10. Inoculate the medium as required.
11. Invert the bottle several times.
12. Clean the patient’s skin if applicable.
13. Label the specimen with patient details (required identification information, including the site of blood collection)
14. Dispose of used and contaminated materials.
15. Thank the patient, remove gloves, and sanitize hands.
16. Transport specimens to the lab as quickly as possible.

Question 24

In performing friction scrub, maximum area of treatment by one applicator is approximately how many inches (dimension)?

Answer 24

2.5 by 2.5 inches

Question 25

T/F: Antisepsis occurs instantly.

Answer 25

False; Antisepsis does not occur instantly; allow air site to dry.

Question 26

T/F: Never blot, fan, or blow on the site, most especially after disinfection.

Answer 26

True

Question 27

What are the considerations in inspecting blood culture bottles?

Answer 27

Inspect the bottle for contamination, excessive cloudiness, cracks, and bulging or indented septums. Make certain the bottle is in date and that the vacuum will draw at least 8 cc. Do not use if any defect is noted.

Question 28

T/F: Tops of the culture bottles must be free of contaminants when inoculated.

Answer 28

True

Question 29

T/F: A blood culture bottle has a vacuum that usually exceeds 10 mL; consequently, the user must carefully monitor how much blood is being added to the bottle.

Answer 29

True

Question 30

T/F: If the patient has “difficult” veins and a need to relocate the site is anticipated, the gloved palpating finger must be cleaned in the same manner as the site, including the 30-second contact time.

Answer 30

True

Question 31

T/F: Repalpating can be done directly on the site of needle entry.

Answer 31

False: Repalpating should only be done above or below the site of needle entry.

Question 32

T/F: A bottle can be inserted directly into an ETS holder used for normal specimen collection.

Answer 32

False; It should never be inserted directly into an ETS holder used for normal specimen collection even though it may fit. There is a possibility that medium in the bottle could flow back into the patient’s vein.

Question 33

T/F: The blood should be mixed with the medium, especially if the bottle contains resin beads to neutralize antibiotics in the patient’s blood, giving any bacteria present a chance to grow.

Answer 33

True

Question 34

T/F (Morse Type): If an iodine preparation was used to clean the arm, the iodine should be removed with alcohol or suitable cleanser. Iodine left on the skin can be irritating and even toxic to those with iodine sensitivity.

Answer 34

Both true

Question 35

T/F: Iodine contamination of a blood sample can also cause erroneous results for other tests.

Answer 35

True

Question 36

T/F: In labeling the specimen, noting the collection site (e.g., right arm) or source, such as a port-a-cath, is necessary in case there is a localized infection.

Answer 36

True

Question 37

T/F: Blood culture specimens can be collected after other procedures.

Answer 37

False; ALWAYS collected first

Question 38

T/F: Changing needles prior to transfer to blood culture bottles are no longer recommended.

Answer 38

True

Question 39

T/F: Carefully hold the culture bottle in your hand during inoculating process.

Answer 39

False; NEVER hold the culture bottle in your hand

Question 39

T/F: Carefully hold the culture bottle in your hand during inoculating process.

Answer 39

False; NEVER hold the culture bottle in your hand

Question 40

T/F: When transferring the blood from syringe to culture bottles, direct the flow along the SIDE of the container.

Answer 40

True

Question 41

T/F: Blood is sometimes collected in intermediate collection tubes rather than blood culture bottles.

Answer 41

True

Question 42

T/F (Morse type): Blood cultures should not be drawn through an indwelling IV or arterial catheter unless absolutely necessary. Draws from vascular lines are known to have a high contamination rate and may cause a person to receive antibiotic therapy when a septic condition is not truly present.

Answer 42

Both true

Question 43

What form do we check to know what test to perform and which tubes are to be used first?

Answer 43

Request form/ requisition form

Question 44

How should you identify a patient?

Answer 44

Ask him/ her to state his/ her full name. Do not confirm by stating it first.

Question 45

How should you identify a sleeping patient?

Answer 45

Check for bracelet (in-patient). Compare it with the information on the requisition form. Look for any markings that are attached to the patient (such as IV line with his/ her name) Ask the nurse in charge or the guardian about the patient's name.

Question 46

Why should the arm be inclined when collecting blood?

Answer 46

So there will be flow of blood and for an easier way of collection