How should blood cultures be drawn?

I have had a lot of questions about blood cultures. How many set? How many minutes apart? And so on. I put together this post to settle some of the questions.

Background

Blood cultures are drawn to detect bacteremia. The current systems are very sensitive at detection. In fact at times too sensitive often making false positives if the site of collection was not adequately prepped. This is why two sets of blood cultures should be drawn from two separate sticks in any patient in whom it is indicated. By having two sets they can be compared to determine if a positive is merely a contaminant or real. This can affect real world treatment decisions.

Should single sets be ever drawn?

Probably not. If there are no reasons to draw two sets then there probably no good reasons to draw one either. Often time I will hear of a patient presenting with chest pain get a single set drawn because they were drawing blood anyways. This is wrong practice that is prone to give misleading information than to actually help.

Are three sets ever necessary?

Probably not. Current systems do not need more than 2 sets in a 24 hour period. The exception may be if one is trying to detect line sepsis. Then drawing off each port may be helpful.

Should blood cultures be drawn at different times?

The old practice was often to draw sets 30 minutes apart. This is no longer necessary. They should be drawn together.

Fungal blood cultures?

No longer need to be drawn in special bottles. Standard bottles are sufficient.

What about lines?

CDC no longer recommends culturing from lines. There is a high false positive rate from line draws. Additionally line tip cultures are no longer recommended.

How to reduce false positives

Properly prep the site by allowing the antiseptic to dry before puncturing the vein.

Blood cultures are can be invaluable in identifying bacteremia but improperly collected specimens can cause unnecessary delay in treatment.