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Blood Culture Collection | Blood Culture Procedure Clinical Nursing Skills
Nurses have a number of responsibilities to perform to maintain their patients’ wellbeing, including collecting blood specimens. Blood culture collections are needed to make sure that patients do not have any foreign organisms in their bloodstream that can prevent them from remaining healthy. This relatively simple procedure must be executed correctly to ensure that the patients’ blood samples are not contaminated.
What are Blood Cultures?
Blood cultures are laboratory tests that consist of injecting blood into bottles that contain culture media to determine if microorganisms have entered the patient’s bloodstream. This laboratory test consists of gathering blood for one set of tests. Some blood goes into the anaerobic bottle and the remaining blood goes into the aerobic bottle.
Nurses must know the appropriate volume of blood to extract from each patient. For infants, nurses need a 3 ml syringe to place 0.5 – 1 ml in the aerobic bottle and 0.5 – 1 ml in the anaerobic bottle. Adults require a 20 ml syringe to place 10 ml in the aerobic bottle and 10 ml in the anaerobic bottle. Nurses must use a 20 ml syringe to place 2.5 -10 ml in the aerobic bottle and 2.5 -10 ml in the anaerobic bottle for infants.
It may not be possible to collect 20 ml of blood from some adults. In this case, nurses should take the blood collected and use it all in the aerobic bottle. Nurses should never use more than 10ml of blood in each bottle.
Steps for Drawing Blood Cultures
1.Gather the materials needed to draw a blood culture. The materials include sterile gauze, zip lock specimen bags, tape, patient labels (self-adhesive), gloves, tourniquet, alcohol swabs, chlorhexidine swabs, blood culture bottles (2 bottles for each set), 2 needles (23 or 25 gauge for pediatrics and 22 gauge for adults), and 2 syringes ( 5 cc or pediatrics and 22 cc for adults).
2.Wash hands for at least 15 seconds with soap and warm water. Use the patient’s arm band to identify the patient against the information in the patient’s chart. Explain the process to the patient and answer any questions that the patient has.
3.Prep the cap
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Chest Tube Care | Nursing Care of Chest Tubes Clinical Nursing Skills
As nurses develop nursing skills in the nursing profession, they must learn the proper manner in which to care for chest tubes and how to change the chest tube dressing of their patients. Patients depend on the experience of nurses to ensure that their medical care is as precise as possible.
What is a Chest Tube?
A chest tube goes by many different names, including chest drainage tube and chest drain. The plastic tube enters the side of the patient’s chest to remove blood, air, or fluid from around the heart and lungs.
The lung contains two tissue layers called pleura that contain fluid that assists the lungs with helping patients breathe. Conditions and diseases—such as pleural effusion, emphysema, tumors, heart failure, hemothorax, infection, and pneumothorax—may cause blood, air, or additional fluid to gather in the pleural space.
The chest tube helps the patient breath better by expanding the lungs. Without the use of a chest tube, patients who have certain conditions and diseases may have their lungs collapse if the pressure becomes too great in their chest.
How to Care for Chest Tubes
Nurses have the responsibility to care for their patients’ chest tubes after they have been properly inserted so that the pleural drainage system remains clear and intact. The following are steps to care for chest tubes.
Wash hands thoroughly with soap and warm water and don sterile gloves before coming in contact with the patient.
The chest tube should contain approximately 6 feet of tubing that connects to a collection device located several feet below the patient’s chest. Instruct the patient not to rest the body on the tubing. The nurse should take this time to check the patient’s tubing for twists and kinks in the tubing line. The nurse should also tape the tubing connections to prevent air from leaking out of the tube.
The drainage system has a water seal that operates as a one-way valve. The nurse must add the required amount of saline into the patient’s separate water chamber while ensuring the end of the patient’s tubing remains in the fluid.
Add suctioning to the chest drainage system if necessary, but remember that the amount of suctioning depends of the saline solution’s depth.
The nurse should make a note of the level of drainage at the end of his or her shift. Also, document the color and amount of the drainage in the patient’s notes.
The respiratory status of the patient requires frequent assessment to maintain the patient’s health. Nurses should also make note of decreased breathing sounds near the side of the patient’s chest tube.
To maintain the care of the chest tube, nurses should encourage the patient to perform deep-breathing exercises or coughing.
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Steps on How to Change a Chest Tube Dressing
1.Gather the necessary materials, which include sterile gloves, drain sponges, tape (2 to 4 inches), 4×4” gauze sponges, ChloraPrep, and 5X9” Xeroform gauze.
2.Wash the hands with soap and warm water and put on a pair of sterile gloves.
3.Remove the patient’s old dressing and insect the site of the chest tube for bleeding, redness, air leaks, skin discoloration, condition of sutures, and color and amount of drainage.
4.Remove the old gloves and don a new pair of sterile gloves. Clean the site with ChloraPrep. Use an antiseptic to clean the first two inches of the patient’s chest tube, beginning where the tube exits the skin. Repeat this process twice and allow the area to dry.
5.Use Xeroform to create an air-tight seal at the insertion site of the chest tube for patients receiving trauma services.
6.Split the 4×4 dressing and place it around the patient’s chest tube. Make sure that the opening slits do not overlap. Apply two additional 4×4 sponges over the previous layer of dressing that covers the chest tube.
7.Apply tape over the dressing. Make note of the time and date the dressing was changed.
8.Remove and dispose of the gloves and wash hands thoroughly.
Complications with Chest Tubes
The complications that patients may experience as a result of the chest tube include infection and blood clots in the arm or leg. The blood clots can travel to the patient’s lungs, causing breathing problems and chest pain, which can be life-threatening. The tube can also poke through organs close to the lungs. The chest tube can also move out of place as the patient turns or moves.
Nurses have a great responsibility when it comes to caring for their patients. The patient’s chest tube must receive proper care so that infections and life-threatening conditions do not occur. With practice, nurses will learn to care for chest tubes with ease.
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Proper Venipuncture Technique Using the Multisample Vacutainer System:
1. Open needle package but do not remove needle shield. Thread needle onto holder. If drawing sterile sample, use sterile holder/needle combination.
2. Select tube or tubes appropriate for samples desired. If a sterile specimen is required, use a sterile VACUTAINER Tube. When collecting sterile samples, observe proper skin preperation directions.
3. Tubes that contain additives should be gently tapped to dislodge any additive which may be trapped around the stopper.
4. Inster tube into holder. Push tube stopper onto needle until leading edge of stopper meetes guideline of holder. Tubes will retract slightly. LEAVE IN THIS POSITION. When using 13mm diameter tubes, it is important to center the tubes in the holder when penetrating the stopper, to preclude sidewall penetration and resultant loss of volume.
5. Select site for venipuncture.
6. Apply tourniquet. Prepare venipuncutre site with an appropriate antiseptic.
DO NOT PALPATE VENIPUNCTURE SITE AFTER CLEANSING.
7. Place patient's arm in a downward position.
8. Remove needle shield. Perform venipuncture with arm in a downard prosition and tube stopper uppermost.
9. Push tube onto holder, puncturing diaphragm of stopper.
10. If no blood flows into tube or ceases to flow before an adequate sample is collected, the following steps are suggested to complete satisfactory collection:
Confirm correct position of needle cannula in vein;
If a multiple sample needle is being used, remove the tube and place a new tube into the holder;
If the second tube does not draw, remove needle and discard in approriate disposal device. Repeat procedure from Step 1.
11. When first tube is full and blood flow ceases, remove it from holder.
12. Place succeeding tubes in holder, puncturing diaphragm to initiate flow. Tubes without additives are drawn before tubes with additives.
13. While each successive tube is filling, gently invert the previous tube containing additives 6-8 times. DO NOT SHAKE. Vigorous mixing can cause hemolysis.
14. As soon as blood stops flowing in the last tube, loosen the tourniquet, remove needle from vein, apply pressure to puncture site with dry, sterile swab, until bleeding stops.
15. Apply bandage if desired.
16. After the venipuncture, the top of the stopper may contain residual blood at the puncture site. Proper precautions should be take when handling tubes to avoid contact with blood droplet. Dispose of any holder that becomes contaminated with blood.
17. Needle Disposal: After venipuncture, dispose of needle using appropriate disposal device. DO NOT RESHIELD (RECAP.) If breakage of a tube containing a collected sample should occur, avoid all direct contact with skin (exposed skin) and follow proper pocedures for the cleanup and disposal of infectious waste.
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1.Explain the procedure to the patient and reassure him or her that you will interrupt the procedure if the patient indicates respiratory difficulty. Administer pain medication to postoperative patient before suctioning.
2.Gather equipment and provide privacy for patient.
3.Perform hand hygiene.
4.Assist the patient to a semi-Fowler’s or Fowler’s position if conscious. An unconscious patient should be placed in the lateral position facing you.
5.Turn suction to appropriate pressure.
• Adult: 100 to 120 cm Hg
•Child: 95 to 110 cm Hg
•Infant: 50 to 95 cm Hg
•Adult: 10 to 15 cm Hg
•Child: 5 to 10 cm Hg
•Infant: 2 to 5 cm Hg
6.Place clean towel, if being used, across patient’s chest. Don goggles, mask, and gown, if necessary.
7.Open sterile kit or set up equipment and prepare to suction.
a.Place sterile drape, if available, across patient’s chest.
b.Open sterile container and place on bedside table or overbed table without contaminating inner surface. Pour sterile saline into it.
c.Hyperoxygenate patient using manual resuscitation bag or sigh mechanism on mechanical ventilator.
d.Don sterile gloves or one sterile glove on dominant hand and clean glove on nondominant hand.
e.Connect sterile suction catheter to suction tubing held with unsterile gloved hand.
8.Moisten catheter by dipping it into the container of sterile saline, unless it is one of the newer silicone catheters that does not require lubrication.
9.Remove oxygen delivery setup with unsterile gloved hand if it is still in place.
10.Using sterile gloved hand, gently and quickly insert catheter into the trachea. Advance about 10 to 12.5 cm (4-5 inches) or until patient coughs. Do not occlude Y-port when inserting catheter.
11.Apply intermittent suction by occluding Y-port with thumb and index finger of sterile gloved hand as catheter is being withdraw. Do not allow suctioning to continue for more than 10 seconds. Hyperventilate three to five times between suctioning or encourage patient to cough and deep breathe between suctioning.
12.Flush catheter with saline and repeat suctioning as needed and according to patient’s tolerance of the procedure. Allow patient to rest at least 1 minute between suctioning, and replace oxygen delivery setup if necessary. Limit suctioning events to three times.
13.When procedure is completed, turn off suction and disconnect catheter from suction tubing. Remove gloves inside out and dispose of gloves, catheter, and container with solution in proper receptacle. Perform hand hygiene.
14.Adjust patient’s position. Auscultate chest to evaluate breath sounds.
15.Record time of suctioning and nature and amount of secretions. Also note character of patient’s respirations before and after suctioning.
16.Offer oral hygiene.