Fever and sepsis work-ups are a routine part of intensive care
unit (ICU) care and particularly challenging due to indwelling catheters,
and the lack of veins in chronically critically ill patients.
- ▪ Aerobic media: Culture media specifically designed
to support the growth of aerobic media (Figure 55-1)
- ▪ Anaerobic media: Culture media specifically designed to
support the growth of anaerobic organisms (Figure 55-1)
Aerobic and anaerobic culture media.
- ▪ A peripheral vein is identified and the skin prepped
with a topical disinfectant such as chlorhexidine or povidine-iodine
- ▪ The operator should wear sterile gloves if a skin-touch
technique is to be used, nonsterile gloves may be used with a no-touch
technique (Figure 55-3).
- ▪ At least 20 cc of blood should be withdrawn from the site
if feasible, and 10 cc injected into both the aerobic and anaerobic
media (Figure 55-4).
Blood sampling using no-touch technique.
Blood sample injected into culture media.
Pearls and Pitfalls
- Many experts recommend against the practice of drawing
blood cultures through existing, indwelling catheters, believing
that catheter contamination without true patient infection may lead
to false-positive results.
Bates DW, Sands K, Miller E, et al. Predicting bacteremia in
patients with sepsis syndrome. J Infect
. 1997;176: 1538–1551.
Shafazand S, Weinacker AB. Blood cultures in the critical care
unit: improving utilization and yield. Chest.