Pre‐procedure

ActionRationale

1. 1.Show
   Introduce yourself to the patient, explain and discuss the procedure with them, and gain their consent to proceed.
   To ensure that the patient feels at ease, understands the procedure and gives their valid consent (NMC [165], C).
2. 2.Show
   Wash hands with bactericidal soap and water then dry, or decontaminate physically clean hands with alcohol‐based handrub.
   To reduce the risk of cross‐infection and specimen contamination (NHS England and NHSI [155], C).
3. 3.Show
   Clean any visibly soiled skin on the patient with soap and water then dry.
   To reduce the risk of contamination (DH [46], C).

Procedure

1. 4.Show
   Apply a disposable tourniquet and palpate to identify vein. Release tourniquet.
   To improve venous access and choose an appropriate vein (Witt [263], E).
2. 5.Show
   Clean skin with a 2% chlorhexidine in 70% isopropyl alcohol swab for 30 seconds and allow to dry for 30 seconds. Do not palpate site again after cleaning.
   To enable adequate skin antisepsis and decontamination, and to prevent contamination from the practitioner's fingers (DH [46], C; WHO [257], C).
3. 6.Show
   Remove flip‐off caps from culture bottles and clean with a second 2% chlorhexidine in 70% isopropyl alcohol swab and allow to dry.
   To reduce the risk of environmental contamination causing false‐positive results (DH [46], C).
4. 7.Show
   Wash and dry hands again or use alcohol handrub and apply non‐sterile gloves (sterile gloves are not essential).
   To decontaminate hands having been in contact with the patient's skin to palpate vein and to prevent cross‐infection. E
5. 8.Show
   Attach winged blood collection set to the appropriate vacuum holder for taking blood cultures.
   To reduce risk of contamination and health and safety risk to practitioner (DH [46], C; WHO [257], C).
6. 9.Show
   Reapply tourniquet.
   To improve venous access. E
7. 10.Show
   Remove sheath covering needle at wings and perform venepuncture.
   To obtain blood samples. E
8. 11.Show
   If blood is being taken for other tests, collect the blood culture first. Inoculate the aerobic culture first.
   To reduce the risk of contamination of culture bottles after inoculating other blood bottles. E
9. 12.Show
   Attach the aerobic bottle first, hold upright and use bottle graduation lines to accurately gauge sample volumes (at least 10 mL in each bottle or as recommended by manufacturer). Remove bottle and replace with anaerobic bottle, take same volume and remove bottle.
   To ensure the anaerobic bottle does not become contaminated with oxygen from the sample (Myers and Reyes [152], E).
10. 13.Show
    Release tourniquet and remove winged device. Apply pressure to the venepuncture site.
    To prevent bleeding at the site (de Verteuil [42], E).

Post‐procedure

1. 14.Show
   Activate safety feature and discard winged collection set in sharps container.
   To reduce risk of sharps injury (HSE [96], C).
2. 15.Show
   Apply appropriate dressing.
   To cover the puncture site after checking the patient has no allergy to the dressing (de Verteuil [42], E).
3. 16.Show
   Remove gloves, discard waste and wash or decontaminate hands.
   To ensure correct clinical waste management and reduce risk of cross‐infection (DH [48], C).
4. 17.Show
   Label bottles with appropriate patient details while in the presence of the patient, ensuring the bar codes on the bottles are not covered or removed.
   To ensure that the specimens from the right patient are delivered to the laboratory, the requested tests are performed and the results are returned to the patient's records (NHSBT [157], C; NHSBT [158], C; NMC [165], C; NPSA [166], C).
5. 18.Show
   Complete microbiology request form (including relevant information such as indications, site and time of culture).
   To maintain accurate records and provide accurate information for laboratory analysis (NMC [165], C; Weston [255], E; WHO [260], C).
6. 19.Show
   Arrange prompt delivery to the microbiology laboratory for immediate processing (or incubate at 37°C).
   To increase the chance of accurate organism identification (Higgins [84], E).
7. 20.Show
   Document the procedure in the patient's records.
   To ensure timely and accurate record keeping (NMC [165], C).