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Effect of Clinical Variables on the Volume of Blood Collected for Blood Cultures in an Adult Patient Population

Published online by Cambridge University Press:  21 November 2017

R. Logan Jones
Affiliation:
Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska
Harlan R. Sayles
Affiliation:
Department of Biostatistics, University of Nebraska Medical Center, Omaha, Nebraska
Paul D. Fey
Affiliation:
Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska
Mark E. Rupp*
Affiliation:
Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska
*
Address correspondence to Mark E. Rupp, 985400 Nebraska Medical Center, Omaha, NE 68198; (merupp@unmc.edu).

Abstract

OBJECTIVE

To identify clinical variables that influence blood culture volume recovery

DESIGN

Retrospective chart review and linear model analysis

SETTING

A 621-bed Academic Medical Center with a Clinical Laboratory that processes 20,000+ blood cultures annually and dedicated phlebotomy staff for venipuncture

PATIENTS

Consecutive patients requiring blood culture

METHODS

Over a 6-day period, blood volume was determined in 568 culture bottles from 128 unique adult patients, and clinical data from the time of phlebotomy were extracted from hospital electronic medical records. Conditional hierarchical linear models with random effects for patient and phlebotomy occasion were utilized to analyze correlations between values collected from the same patient and during the same phlebotomy occasion.

RESULTS

Blood samples obtained from a central venous catheter yielded, on average, 2.53 mL more blood (95% CI, 1.63–3.44 mL; P<.001) than those from peripheral venipuncture, and aerobic bottles contained 0.38 mL more blood (95% CI, 0.1–0.67 mL; P=.009) than the anaerobic bottles. The remaining clinical variables (eg, hospital department, patient age, body mass index, gender, mean arterial pressure, concomitant systemic antibiotic use, and Charlson comorbidity index score) failed to reach statistical significance (P<.05) in relation to volume.

CONCLUSIONS

Blood cultures obtained from central venous catheters contain significantly greater volume than those obtained via peripheral venipuncture. These data highlight the clinically significant issue of low culture volume recovery, indicate that diagnostic and prognostic tools that rely on volume-dependent phenomena (ie, time to positivity) may require further validation under usual clinical practice circumstances, and suggest goals for future institutional performance improvement.

Infect Control Hosp Epidemiol 2017;38:1493–1497

Type
Original Articles
Copyright
© 2017 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

PREVIOUS PRESENTATION: This work was presented as an abstract at IDWeek on October 26, 2016, in New Orleans, Louisiana.

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