Blood Cultures HCI

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					UTAH BLOOD & MARROW TRANSPLANT PROGRAM

BLOOD CULTURES ON BMT PATIENTS
                                                                                Page 1 of 3

PRINCIPLE
Infection in the immuno-compromised host is a serious complication of blood and
marrow transplantation (BMT). Neutropenic fevers should be treated as an oncologic
emergency. Early antibiotic treatment is imperative and delay significantly increases
morbidity and mortality.

PURPOSE
1. To standardize the procedure for drawing blood cultures on active transplant patients
with first fever spikes.
2. To standardize the procedure for drawing blood cultures on transplant patients with
subsequent fever spike after first fever spike.
3. To standardize the procedure for drawing blood cultures on outpatients in the clinic.

Celsius   Fahrenheit Celsius         Fahrenheit Celsius        Fahrenheit

38.5      101.3         39.2         102.6        39.9         103.8
38.6      101.5         39.3         102.7        40           104
38.7      101.7         39.4         102.9        40.1         104.2
38.8      101.8         39.5         103.1        40.2         104.4
38.9      102           39.6         103.3        40.3         104.5
39        102.2         39.7         103.5        40.4         104.7
39.1      102.4         39.8         103.6        40.5         104.9
                                                  40.6         105.1


First neutropenic fever spike on active transplant patients
   1. Tympanic temperatures will be taken every 4 hours or more often if patient feels
       warm or flushed.
   2. Blood cultures will be drawn from all lumens when the core temperature is above
       38.1 C. Notify the on-call provider. A set of aerobic and anaerobic cultures will
       be drawn from each port and one fungal culture from one port.
   3. Clean tops of bottles as well as tips of catheter with alcohol and allow to dry.
   4. Recognizing first fever spike include
           a. No previous fevers that were documented.
           b. Active transplants patients will be on a once daily quinolone which is
              Levaquin 500mg PO upon admission When the
           c. Patients unable to take PO, they will receive IV quinolone(levoquin)
           d. With first fever > 38.1 C, the provider will begin empiric Meropenem
              500mg IV q8hrs and levoquin will be stopped. Meropenem is a broad
              spectrum antiobiotic that covers gram neg., gram positive and anaerobes.
              This antibiotic does not cover coag-neg staph and MRSA.
UTAH BLOOD & MARROW TRANSPLANT PROGRAM

BLOOD CULTURES ON BMT PATIENTS
                                                                                 Page 2 of 3

          e. If a patient has a subsequent or persistent fever spikes >39 /24 hours after
              Meropenem is started and patient is not on Vanco, Gentamycin or
              Ampho., notify on call provider.
          f. If Vancomyacin is started, rotate between all ports. Record which port is
              used in the eMAR when charting when giving.
    5. Complete three Infectious Diseases lab slips and specify which port drawn from.
       Check # 60103 Blood Cuture, Bottles(ID, S) on each slip and on one slip check
       #60149 Fungal Culture(ID). Label lab slip with which port drawn from.
    6. Label bottles with date, time, initial and port drawn from also. Draw from red,
       white and then blue and label 5 minutes apart in order drawn.
    7. Always label which port BC is drawn from for subsequent fever spike.

    Drawing blood cultures on subsequent fever spikes after Meropenem(unless
    allergic) had been started.
    1. Clean bottles and catheter tips with alcohol and friction and allow to dry.
    2. Draw one set of anaerobic and aerobic blood cultures and one fungal culture
        every 24 hours.
    3. Complete Infectious Diseases lab slips and specify which port that was drawn
        from. Check # 60102 Blood Cuture, Bottles(ID, S) and check# 60149 Fungal
        Culture(ID).
    4. Label bottles with date, time, initial and port draw from also. Rotate ports ie Red,
        white and finally blue.
    5. Assess antibiotic status. If a patient has a continuous fever spikes >38.1 after
        Meropenem is started and patient is not on Vanco, Gent. or Ampho, call provider
        again especially if fever is >39 C/102.2 F. Assess respiratory status also for <8
        or >30 and blood pressure for sepsis.

    Drawing blood cultures on out patients in the clinic

    1.   Blood cultures will be drawn from all lumens when the Core fever is above 38.1
         C as well as calling the on call provider. A set of aerobic and anaerobic cultures
         will be draw from each port and one fungal culture from one line.
    2.   Complete three Infectious Diseases lab slips and specify which port that was
         drawn from. Check # 60102 Blood Cuture, Bottles(ID, S) on each slip and on one
         slip check# 60149 Fungal Culture(ID).
    3.   Clean bottles and catheter tips with alcohol and friction and allow to dry.
    4.   Label bottles with date, time, initial and port drawn from also. Rotate ports ie
         Red, white and finally blue.
    5.   Rotate Meropenem on readmits or suspected line infections.
    6.   Vancomycin is rotated on all patients.


Date of Origin: 5/2006
Date of Revision: 4/08
Date of Review: 5/08
UTAH BLOOD & MARROW TRANSPLANT PROGRAM

BLOOD CULTURES ON BMT PATIENTS
                                                          Page 3 of 3


                                ____________________________
                                Colleen Bruch
                                Inpatient BMT Nurse Manager

                                ____________________________
                                Kim Noteboom RN
                                Clinical Nurse Specialist

				
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posted:11/18/2011
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