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Original research
The practice of blood volume submitted for culture in a neonatal intensive care unit
  1. Moni Pankhuri Singh1,
  2. Kiran Kumar Balegar V1,2,
  3. Rajeshwar Reddy Angiti3
  1. 1Neonatal Intensive Care Unit, Nepean Hospital, Penrith, New South Wales, Australia
  2. 2The University of Sydney, Sydney Medical School Nepean, Sydney, New South Wales, Australia
  3. 3NSW NETS, Bankstown Aerodrome, New South Wales, Australia
  1. Correspondence to Dr Kiran Kumar Balegar V, Neonatal Intensive Care Unit, Nepean Hospital, Penrith, NSW 2747, Australia; Kiran.Balegarv{at}health.nsw.gov.au

Abstract

Background Neonatal sepsis is the leading cause of mortality and morbidity in neonatal intensive care units. The volume of blood taken for culture remains one of the most important factors in isolating microorganisms.

Objectives To evaluate the impact of the intervention on the blood volume submitted for culture and to identify factors influencing the volume as determined by the phlebotomist.

Methods Blood culture volume was determined by weighing the culture bottle before and immediately after blood inoculation. A 3-month preintervention audit revealed that in 126/130 samples (96.9%), the volume of blood submitted was suboptimal. Multiple intervention measures were instituted, and volume was monitored over the next 9 months.

Results 637 blood culture samples were included in the study, 130 were in preintervention and 507 were in postintervention epochs. Following the intervention, suboptimal volume samples reduced from 96.9% (126/130 samples) to 25% (126/507 samples), p<0.0001 and the median (IQR) sample volume improved from 0.36 (0.23) ml to 0.9 (0.27) ml, p<0.0001. Poor blood flow was identified as the most common reason for an inadequate sample.

Conclusion The study underscores the role of educational intervention in improving the blood culture volume in newborn infants. Poor backflow from the cannula is an important cause of inadequate volume collection.

  • blood culture
  • contamination
  • blood volume
  • neonatal sepsis

https://doi.org/10.1136/archdischild-2019-318080

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    Footnotes

    • MPS and KKBV are joint first authors.

    • Twitter @Kumar@kiranku98020067, @RAngiti

    • Contributors MPS: Implementing CPI, collection of data and writing the draft manuscript. RA: Compiling tables, graphs, statistics. KKBV: Conceptualisation, coordinating CPI, critically analysing the results, substantial editing and final approval of the manuscript. MPS and KKBV are equal first authors.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval The study was approved by the local ethics committee at Nepean Hospital (Project No: 17-40(A)).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.