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)
    • No more than 3 BC sets should be taken in any 24 hour period.
    • 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) Within 6 hours of 1st BC

    • An additional single BC set should be taken from any lumen prior to the 2nd IV antibiotic dose (omit this BC if 3 BC sets were taken pre-antibiotics or the patient does not have a CVAD).

    c) Subsequent BCs

    • Daily BC sets from every lumen on day 2 and 3

    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)
    6ml If anaerobic BC not indicated put 10 ml in aerobic bottle 6 ml
    21 - 25kg 8ml If anaerobic BC not indicated put 10 ml in aerobic bottle 8 ml
    >25 Kg 10ml 10 ml

    Prepared by Dr Gabrielle Haeusler with Prof Nigel Curtis (Infectious Diseases) and Prof Paul Monagle (Oncology)                   March 2011