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, or decontaminate physically clean hands with alcohol‐based handrub. Apply gloves.
   To reduce the risk of cross‐infection and specimen contamination (DH [46], C).

Procedure

1. 3.Show
   Prepare a cleaned trolley and sterile intravenous or dressing pack.
   To ensure a clean and suitable workplace. E
2. 4.Show
   Clean the end of each lumen with 2% chlorhexidine in 70% isopropyl alcohol swab and allow to dry for 15 seconds (if continuous life‐sustaining infusions are running, this may not be possible from this lumen, so an alternative lumen must be used).
   To enable adequate antisepsis and decontamination of each lumen (NHS England and NHSI [155], C; Rhodes et al. [206], C).
3. 5.Show
   Remove flip‐off caps from culture bottles and clean with a 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. 6.Show
   Using a 10 mL syringe, take and discard at least 10 mL of blood prior to attaching blood culture bottles.
   To remove any 0.9% sodium chloride or other drug residue that may be present in the lumen (Danckers and Fried [41], E).
5. 7.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
6. 8.Show
   Attach adapter to holder and then attach vacuum‐assisted collection system to hub of central venous access device (CVAD). Insert blood culture bottle and puncture septum.
   To initiate vacuum collection. E
7. 9.Show
   Attach 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.
   To reduce the risk of a false‐negative result due to insufficient volume or overdiluted culture medium (Higgins [84], E).
8. 10.Show
   Repeat steps 5–9 with each lumen if a multilumen device is in situ.
   To accurately determine whether the CVAD is the source of infection (Rhodes et al. [206], C).
9. 11.Show
   Remove and discard the vacuumed collection holder in the sharps container.
   To reduce risk of sharps injury and ensure correct waste management (DH [48], C).
10. 12.Show
    Flush with at least 10 mL 0.9% sodium chloride using the push–pause method (i.e. 1 mL at a time) and end with positive pressure.
    To remove blood from the lumen and maintain patency (Dougherty [53], E).

Post‐procedure

1. 13.Show
   Remove and dispose of gloves and wash or decontaminate hands.
   To ensure correct clinical waste management and reduce risk of cross‐infection (DH [48], C).
2. 14.Show
   Label bottles with appropriate patient details, ensuring the bar codes on the bottles are not covered or removed.
   To ensure correct patient and sample identity and to aid traceability within the laboratory. E
3. 15.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).
4. 16.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).
5. 17.Show
   Document the procedure in the patient's records.
   To ensure timely and accurate record keeping (NMC [165], C; WHO [260], C).