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Introduction

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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.

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Definitions and Terms

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  • ▪  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)

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Figure 55-1.
Graphic Jump Location

Aerobic and anaerobic culture media.

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Techniques

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  • ▪  A peripheral vein is identified and the skin prepped with a topical disinfectant such as chlorhexidine or povidine-iodine (Figure 55-2).
  • ▪  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  • ▪  At least 20 cc of blood should be withdrawn from the site if feasible, and 10 cc injected into both the aerobic and anaerobic media (Figure 55-4).

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Figure 55-3.
Graphic Jump Location

Blood sampling using no-touch technique.

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Figure 55-4.
Graphic Jump Location

Blood sample injected into culture media.

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Clinical Pearls and Pitfalls

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  • 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.

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Suggested Reading

Bates DW, Sands K, Miller E, et al. Predicting bacteremia in patients with sepsis syndrome. J Infect Dis. 1997;176: 1538–1551.  [PubMed: 9395366]
Shafazand S, Weinacker AB. Blood cultures in the critical care unit: improving utilization and yield. Chest. 2002;122:1727–1736.  [PubMed: 12426278]

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