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PMTP 2 (2nd Shift) > Unit 6 > Flashcards

Unit 6 Flashcards

1
Q

helps determine the presence and extent of infection as well as indicating the type of organism responsible and the antibiotic to which it is most susceptible

A

Blood culture

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2
Q

When are blood cultures typically ordered?

A

immediately before or after anticipated fever spikes when bacteria are most likely to be present

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3
Q

Blood culture examination is requested or performed to detect the causes of?

A

Fever of unknown origin (FUO)
Bacteremia – bacteria in the blood
Septicemia – microorganisms or their toxins in the blood
Fungemia – fungi or yeasts in the blood

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4
Q

T/F:
Blood is collected prior to the fever peak.

A

True

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5
Q

How many blood cultures are necessary to optimize the detection of bacteremia and fungemia according to American Society for Microbiology (ASM)?

A

2 to 4 blood cultures

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6
Q

For optimum results, blood specimens should be drawn how many minutes apart?

A

30 to 60 minutes

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7
Q

VOLUME OF BLOOD PER CULTURE:
Infants and younger children

A

1% to 4% of the patient’s total blood volume
(typically 1-2 mL per draw)

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8
Q

VOLUME OF BLOOD PER CULTURE:
Adults or people weighing more than 80 pounds

A

20 to 30 mL per culture with a minimum of 10 mL per draw

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9
Q

Blood culture specimens are most commonly collected in special bottles containing _________ _________ (referred to as medium) that encourages the growth of microorganisms.

A

nutrient broth

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10
Q

Specimens are typically collected in special bottles in sets of two, which are?

A

one aerobic (with air)
one anaerobic (without air)

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11
Q

When a syringe is used to collect the blood, which bottle is filled first?

A

anaerobic bottle

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12
Q

When a butterfly is used, which bottle is filled first?

A

aerobic bottle;
because air in the tubing will be drawn into it along with the blood.

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13
Q

A critical part of the blood culture collection procedure

A

SKIN ANTISEPSIS

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14
Q

Skin antisepsis is frequently referred to as?

A

prepping the skin

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15
Q

Why is skin antisepsis performed?

A

to remove soil and transient microorganisms on the skin

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16
Q

T/F:
Failure to carefully disinfect the venipuncture site can introduce skin-surface bacteria into the blood culture bottles and interfere with interpretation of results.

A

True

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17
Q

How many seconds of friction scrub do the collection sites require to get to the bacteria beneath the dead skin cells onto the surface of the arm?

A

30- to 60-second friction scrub

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18
Q

ANTISEPTICS USED TO CLEAN THE SITE OF COLLECTION FOR BLOOD CULTURE

A

10% povidone iodine
1% to 2% tincture of iodine
Chlorhexidine gluconate
70% ethyl alcohol

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19
Q

T/F:
In using a povidone–iodine or chlorhexidine gluconate ampule swab, the swab should be placed above the site of needle insertion and moved inward in concentric circles, going over the area more than once.

A

False;
AT the site of needle insertion
OUTWARD in concentric circles
WITHOUT going over any area again

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20
Q

The area covered should be how many inches in diameter?

A

3-4 inches

21
Q

Because of the increasing incidence of iodine sensitivities, some healthcare facilities are using this antiseptic preparation in blood culture preparation kits that have a one-step application and are effective with a 30-second scrub.

A

chlorhexidine gluconate/isopropyl alcohol

22
Q

T/F:
According to the CLSI, chlorhexidine gluconate is the recommended blood culture site disinfectant for infants younger than 2 months and patients with iodine sensitivity.

A

False;
2 months and older

23
Q

Enumerate the steps in performing blood culture specimen collection

A
  1. Follow normal identification protocol, and explain the collection procedure.
  2. Identify venipuncture site, and release the tourniquet.
  3. Aseptically select and assemble equipment.
  4. Perform friction scrub.
  5. Allow air site to dry.
  6. Remove the flip off cap and inspect the bottle for defects.
  7. Cleanse the culture bottle stoppers while the venipuncture site is drying.
  8. Mark the minimum and maximum fill on the culture bottles.
  9. Reapply the tourniquet and perform the venipuncture without touching or repalpating the site.
  10. Inoculate the medium as required.
  11. Invert the bottle several times.
  12. Clean the patient’s skin if applicable.
  13. Label the specimen with patient details.
  14. Dispose of used and contaminated materials.
  15. Thank the patient, remove gloves, and sanitize hands.
  16. Transport specimens to the lab as quickly as possible.
23
Q

Enumerate the steps in performing blood culture specimen collection

A
  1. Follow normal identification protocol, and explain the collection procedure.
  2. Identify venipuncture site, and release the tourniquet.
  3. Aseptically select and assemble equipment.
  4. Perform friction scrub.
  5. Allow air site to dry.
  6. Remove the flip off cap and inspect the bottle for defects.
  7. Cleanse the culture bottle stoppers while the venipuncture site is drying.
  8. Mark the minimum and maximum fill on the culture bottles.
  9. Reapply the tourniquet and perform the venipuncture without touching or repalpating the site.
  10. Inoculate the medium as required.
  11. Invert the bottle several times.
  12. Clean the patient’s skin if applicable.
  13. Label the specimen with patient details (required identification information, including the site of blood collection)
  14. Dispose of used and contaminated materials.
  15. Thank the patient, remove gloves, and sanitize hands.
  16. Transport specimens to the lab as quickly as possible.
24
Q

In performing friction scrub, maximum area of treatment by one applicator is approximately how many inches (dimension)?

A

2.5 by 2.5 inches

25
Q

T/F:
Antisepsis occurs instantly.

A

False;
Antisepsis does not occur instantly; allow air site to dry.

26
Q

T/F:
Never blot, fan, or blow on the site, most especially after disinfection.

A

True

27
Q

What are the considerations in inspecting blood culture bottles?

A

Inspect the bottle for contamination, excessive cloudiness, cracks, and bulging or indented septums.
Make certain the bottle is in date and that the vacuum will draw at least 8 cc.
Do not use if any defect is noted.

28
Q

T/F:
Tops of the culture bottles must be free of contaminants when inoculated.

A

True

29
Q

T/F:
A blood culture bottle has a vacuum that usually exceeds 10 mL; consequently, the user must carefully monitor how much blood is being added to the bottle.

A

True

30
Q

T/F:
If the patient has “difficult” veins and a need to relocate the site is anticipated, the gloved palpating finger must be cleaned in the same manner as the site, including the 30-second contact time.

A

True

31
Q

T/F:
Repalpating can be done directly on the site of needle entry.

A

False:
Repalpating should only be done above or below the site of needle entry.

32
Q

T/F:
A bottle can be inserted directly into an ETS holder used for normal specimen collection.

A

False;
It should never be inserted directly into an ETS holder used for normal specimen collection even though it may fit. There is a possibility that medium in the bottle could flow back into the patient’s vein.

33
Q

T/F:
The blood should be mixed with the medium, especially if the bottle contains resin beads to neutralize antibiotics in the patient’s blood, giving any bacteria present a chance to grow.

A

True

34
Q

T/F (Morse Type):
If an iodine preparation was used to clean the arm, the iodine should be removed with alcohol or suitable cleanser. Iodine left on the skin can be irritating and even toxic to those with iodine sensitivity.

A

Both true

35
Q

T/F:
Iodine contamination of a blood sample can also cause erroneous results for other tests.

A

True

36
Q

T/F:
In labeling the specimen, noting the collection site (e.g., right arm) or source, such as a port-a-cath, is necessary in case there is a localized infection.

A

True

37
Q

T/F:
Blood culture specimens can be collected after other procedures.

A

False;
ALWAYS collected first

38
Q

T/F:
Changing needles prior to transfer to blood culture bottles are no longer recommended.

A

True

39
Q

T/F:
Carefully hold the culture bottle in your hand during inoculating process.

A

False;
NEVER hold the culture bottle in your hand

39
Q

T/F:
Carefully hold the culture bottle in your hand during inoculating process.

A

False;
NEVER hold the culture bottle in your hand

40
Q

T/F:
When transferring the blood from syringe to culture bottles, direct the flow along the SIDE of the container.

A

True

41
Q

T/F:
Blood is sometimes collected in intermediate collection tubes rather than blood culture bottles.

A

True

42
Q

T/F (Morse type):
Blood cultures should not be drawn through an indwelling IV or arterial catheter unless absolutely necessary. Draws from vascular lines are known to have a high contamination rate and may cause a person to receive antibiotic therapy when a septic condition is not truly present.

A

Both true

43
Q

What form do we check to know what test to perform and which tubes are to be used first?

A

Request form/ requisition form

44
Q

How should you identify a patient?

A

Ask him/ her to state his/ her full name. Do not confirm by stating it first.

45
Q

How should you identify a sleeping patient?

A

Check for bracelet (in-patient).
Compare it with the information on the requisition form.
Look for any markings that are attached to the patient (such as IV line with his/ her name)
Ask the nurse in charge or the guardian about the patient’s name.

46
Q

Why should the arm be inclined when collecting blood?

A

So there will be flow of blood and for an easier way of collection

PMTP 2 (2nd Shift) (4 decks)

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