Blood Cultures, Blood Tubes, IV Catheters, and Intraosseous

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This presentation will provide information on Blood Cultures, Blood Tubes, IV Catheters, and Intraosseous devices. I

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Blood Cultures, Blood Tubes, IV Catheters, and Intraosseous :

Blood Cultures, Blood Tubes, IV Catheters, and Intraosseous

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Presented by

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About Kevin And Central Valley Medical Kevin is a high performing RN and Clinical Manager with over 20 years experience, including critical care, PACU, and ED. He is also a trusted and effective Mentor and Supervisor who provides moderate leadership; guides staff as needed while allowing autonomous decision-making. Kevin’s career includes 13 years in the U.S. Army as a combat medic as well as a nurse. He served three tours of combat in Iraq during Desert Shield/Storm. He has also spent 5 years as Charge Nurse and 3 years as Relief House Supervisor as well as a Preceptor for a 300-bed hospital. He has served as a clinical manager for Adventist Health-Selma as well as Central Valley Medical. He has earned an MBA in Health Care Management with Project Management Certificate and a Bachelors of Science in Computer Networking to support management of IT healthcare systems.

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Acknowledgements This e-book would not have been possible without the tireless work of Ms Paat and Central Valley Medical. Table of Contents Blood Cultures………………………………………………………………………………….4 How Much Do I need?..............................................................................................8 Blood Tubes…………………………………………………………………………………….16 Venipuncture Procedure……………………………………………………………………..17 IV Catheters…………………………………………………………………………………….27 Intraosseous……………………………………………………………………………………..35 Final Word………………………………………………………………………………………43

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Blood Cultures Detection of bacteria or fungi in the patient’s blood is extremely important; especially if the healthcare provider suspects infection and or sepsis. Blood cultures are a critical aspect in managing patients with infection, and directs the healthcare provider in choosing the appropriate selection of medications to treat the patient properly. Blood cultures are a common place in laboratory testing and will help correctly diagnose and treat the patient. The medium used in blood culture bottles support the growth of most of the recognized bacteria and fungi, including anaerobes, which grow adequately in the aerobic blood culture bottle. The goal of obtaining blood cultures is to determine whether a microorganism(s) is responsible for the patient’s clinical presentation. On the other hand, if the provider fails to follow the correct blood culture procedure it may result in what is known a ‘False positive’. This can directly affect the outcome of the patient’s diagnosis as well as the treatment plan.

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A ‘False Positive’ may result when the provider contaminates the specimen(s) with an organism that is not related to the patient. This error typically occurs because the provider fails to properly clean the skin of the patient as well as incorrect cleaning of the Blood Culture Bottles itself. Another barrier to incorrect interpretation of blood culture results is inadequate clinical information that should typically accompany the patient. (i.e. request forms, pt info, etc. etc.) Following standards of practice as well as your company's policy and procedures will help in the management of sepsis as well as obtaining an appropriate blood culture specimen; thus reducing false-positives.

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Blood Cultures

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Aerobic

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How much Blood Do I need? Typically the Aerobic needs 8-10ml. If you are not certain; simply look on the specimen bottle

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Anaerobic

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If you forget whether it is Aerobic or Anaerobic just look at the bottle

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The Anaerobic specimen uses approx. 5-7ml of blood

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Pediatric Pediatric Blood Cultures have a Pink Top and only use 1 bottle .

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On occasion the Peds Blood Culture tube may be used for an Adult

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Pediatric specimens typically only require one specimen bottle and approx. 1-3ml of blood

Blood Tubes:

Blood Tubes When drawing blood samples from the patient, the provider should always follow the order of draw. The ORDER OF DRAW is as follows: 1. blood culture bottle 2. light blue top or coagulation tube 3. non-additive tube (red top) 4. additive tubes in this order: Red-black or gold top or SST Dark green top or Sodium heparin light green top lavender top pale yellow top gray top)

VENIPUNCTURE PROCEDURE:

VENIPUNCTURE PROCEDURE The venipuncture procedure is a simple skill; however, it does require knowledge of the blood tubes and order of draw. Each provider generally establishes a routine that is comfortable for himself/herself. The following steps are required for the venipuncture procedure: Identify the patient. Assess the patient Check the doctors order and compare to lab test order Select a suitable site for venipuncture. Prepare the equipment, the patient and the puncture site Perform the venipuncture. Collect the sample in the appropriate tube Assess the need for recollection of specimen (if needed) Label the collection tubes at the bedside Promptly send the specimens with the requisition to the lab

LABELING THE SAMPLE:

LABELING THE SAMPLE A properly labeled blood tube is a key part of this process. The following elements should be included when labeling the tubes: Patient's first and last name Patient's ID number. Date, time and initials of the provider

Learn Your Colors:

Learn Your Colors

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Grey-top Tube Grey Top can be used for Alcohol levels or Lactic Acid

Pink Top:

Pink Top Pink tubes are normally used for Type and Cross and or Type and Screen

Red Top:

Red Top Red tops are normally used for drug levels

Dark Green Top:

Dark Green Top For lithium level, use sodium heparin For ammonia level, use sodium or lithium heparin

Lavender:

Lavender Lavender tops are typically used for Complete Blood Counts (CBC) or H&H

Blue:

Blue Light blue tops are used for coagulation test such as a PT/PTT

Pedi-Tubes:

Pedi-Tubes Pedi-Tubes are 1ml and used for children and infants

IV Catheters:

IV Catheters IV catheters come in various sizes and lengths. The provider should determine where they will start the IV and what type of fluid they will infuse before selecting their catheter.

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Catheters range in size from 14 gauge to 24 gauge . The smaller the number the larger the diameter of the sheath and needle. Typically 24g-22g are used for small children and older adults. Sizes 20g-18g are the typical size used in the ER, Med/Surg, and other areas of the hospital and clinics. Sizes and Lengths

14 gauge:

14 gauge Typically used for Needle Decompression

16 gauge:

16 gauge Grey catheter is large and used for trauma patients

18 gauge:

18 gauge Standard catheter used in the ED and Operating room

20 gauge:

20 gauge Used for adult patients; typically on a Medical/Surgical Floor

22 gauge:

22 gauge Used for older adults and children

24 gauge:

24 gauge Used for older adults and children

Intraosseous:

Intraosseous The Intraosseous (IO) was first examined over 80 years ago and it was not until recently that this procedure was most commonly used for pediatric patients. However, the use of the IO is making a great comeback as it has been discovered that the bone marrow has ventricles that may lead directly to the central circulatory system. The IO like an IV catheter can infuse fluids and medications in an effective and rapid manner.

IO Contraindications :

IO Contraindications Contraindications to initiating an Intraosseous infusion are small; however, important. The one universal contraindication for IO access is a fracture of the bone that is to be used as the access site. Other contraindications to IO access include: Osteogenesis severe osteoporosis cellulitis

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Access Sites Where should an IO device be placed?

Placement:

Placement Typically, the suggested sites for an IO infusion in children have been the proximal or distal tibia. In adults, the most commonly recommended sites are the sternum or the tibia. However, there are other options, including the radius, ulna, pelvis, clavicle and calcaneus.

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IV Connection

Complications:

Complications Potential complications for an IO are typically the following: Osteomyelitis Infiltration Compartment Syndrome

FAST IO:

FAST IO The FAST IO is used and inserted into adults in the sternum

Conclusion:

Conclusion Whether you are starting an IV, drawing blood and blood cultures, or using an IO; as a healthcare professional you must know and understand the equipment and procedures for these processes. Use this guide as a simple tool to help you build a foundation.

Final Word:

Final Word Sign Up for the Central Valley Medical Newsletter Each month, Central Valley Medical sends out an e-newsletter that provides free tools, tips and tutorials to healthcare professionals around the globe. Email Us info@central-valley-med.com

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