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Clinical Practice Guidelines

Childrens cancer centre - blood culture

  • Number, site and timing of blood cultures

    • A minimum of 2 BC sets should be taken prior to the 1st antibiotic dose (but do not delay antibiotics)
    • A BC set consists of one catheter access draw inoculated into:
      (i) an aerobic BC bottle; (ii) when indicated, an anaerobic BC bottles (see below).
    • Peripheral BCs are no longer routinely recommended in oncology patients
    • Always label BC bottle with site from which blood has been taken including specific lumen.
    • In the event of a new episode of fever or change in antibiotic regimen repeat steps a to c (below)

    a) Pre-antibiotics

    No CVAD 2 BC sets taken from separate peripheral sites
    or taken by separate draws from one peripheral site
    CVAD with 1 lumen 2 BC sets taken by separate draws
    CVAD with >= 2 lumens 1 BC set from each of all lumens
    >= 2 CVADs (ie Port + Hickman) 1 BC set from every lumens of both CVADs

    b) Subsequent (post-antibiotic) blood cultures

    • Afebrile and well – repeat BCs are not required
    • Ongoing fever or clinical instability – repeat one blood culture set on Day 2 from any lumen (+/- Day 3 if fever persists)

    c) Repeat steps (a) and (b) if:

    • new onset fever (after >48h afebrile) or clinical instability; or
    • change to antibiotics or
    • to confirm/exclude positive BC result 

    2. Volume and type of blood culture

    Aerobic BC  Anaerobic BC
     If inadequate volume for both aerobic and anerobic BC bottles the aerobic bottle should be inoculated preferentially Indications

    1. GI symp (abdo pain, V or D) or
    2. Severe mucositis or
    3. GI, urological or gynae malig
    Weight                      Yellow aerobic bottle
    (for small vols)     		 Green aerobic bottle
    (for larger vols)     		 Orange anaerobic bottle

    Min vol: 0.5 mL
    Max vol: 4 mL

    Min vol: 5 mL
    Max vol: 10 mL

     <1.5 kg

    		  1 mL  

    Discuss with Registrar

     

     
    1.5 - 5 kg  1.5 mL  
    5 - 10 kg 3 mL     5 mL
    (No more than 2 anaerobic BC in 24h)
    11 - 15 kg  4 mL   5 mL
    16 - 20 kg (Use green bottle
    whenever >4 mL collected)    		 6 mL If anaerobic BC not indicated put 10 mL in aerobic bottle 6 mL
    21 - 25kg 8 mL If anaerobic BC not indicated put 10 mL in aerobic bottle 8 mL
    >25 Kg 10 mL 10 mL

    Last updated October 2019