Ch 18: Laboratory Specimen Collection - Obtain Venous Blood Specimen for Culture and Sensitivity

A nurse is collecting a venous blood specimen from an adult for culture and sensitivity. Which actions should the nurse perform? Select all that apply.

- Clean the client's skin at the puncture site with an antimicrobial swab. - Collect two bottles of specimen, totalling 30 mL. - Collect the specimens from two different sites. - Collect blood-culture specimens before other specimens. Rationale: If tests are prescribed in addition to the blood cultures, the nurse should collect the blood-culture specimens before other specimens, to lessen the likelihood that the culture samples will be contaminated due to other tests. In this procedure, a venous blood sample is collected by venipuncture into two bottles (one set), one containing an anaerobic medium and the other an aerobic medium. Currently, best practice is to draw blood one time, obtaining at least 30 mL of blood (for adults) from two different venipuncture sites. Cleaning the client's skin reduces the risk for transmission of microorganisms. With the bevel of the needle up, the nurse should insert the needle into the vein at a 15-degree angle to the skin, not a 45-degree angle.

The nurse must obtain a venous blood specimen for culture and sensitivity. The client is very anxious about having the procedure and wants to know each step beforehand. When explaining the procedure, where will the nurse tell the client that the tourniquet will be placed?

3 to 4 in (7.5 to 10 cm) above the selected site Rationale: The proper placement of a tourniquet is 3 to 4 in (7.5 to 10 cm) above the selected site. The tourniquet should not be placed below or too close to the selected venipuncture site.

After the venipuncture site has been selected and disinfected, what should the nurse do next?

Avoid touching the clean site prior to needle puncture. Rationale: For asepsis, the nurse should avoid touching the clean site prior to needle puncture. The clean site should not be repalpated to avoid contamination. The tourniquet should stay in place during the needle puncture. The cleaning solution should be allowed to dry completely prior to needle puncture.

The nurse must obtain a venous blood specimen for culture and sensitivity. Why does the nurse gather two separate collection bottles?

Each collection bottle contains a different type of medium allowing for different types of bacteria growth. Rationale: Each collection bottle for culture and sensitivity contains a different type of medium allowing for different types of bacteria growth. Therefore, blood is not placed in two collection bottles just to ensure there is an adequate amount. Blood is not placed in two collection bottles to be used for future testing.

A nurse is preparing to collect a venous blood specimen for culture and sensitivity from a client. The client has large, distended, highly visible veins in both arms. Which action should the nurse take when collecting blood from this client?

Perform venipuncture on an arm without a tourniquet. Rationale: When performing venipuncture on a client who has large, distended, highly visible veins, the nurse should simply proceed without using a tourniquet to minimize the risk for hematoma. The nurse should not use veins in the lower extremities for venipuncture, because of an increased risk of thrombophlebitis. Applying warm compresses to the selected site 15 to 20 minutes before venipuncture is done to aid in distending veins that are difficult to locate; thus, this action is not necessary in this case, as the veins are already distended. There is no need to stop the procedure or notify the client's health care provider.