TABLE 1.

Recommended phlebotomy protocol

Step	Blood culture study protocola
1	Obtain one envelope from the “antiseptic skin prep for blood culture” box. Each of these packages will contain three swabsticks soaked in an antiseptic agent. Blood culture bottles, tourniquet, syringe(s), butterfly needles, alcohol pads, gauze pads, and bandage(s) should also be obtained.
2	Select the site of venipuncture. (If the patient is unusually dirty, wash the intended site with soap and water prior to venipuncture.)
3	Put on exam gloves.
4	Open the package and remove one swabstick.
5	Scrub the venipuncture site gently but firmly with the swabstick beginning in the center and continuing in an outward direction using circular strokes for an area 2 to 3 in. in diameter.
6	Repeat this procedure for the two remaining swabsticks.
7	After the third swab, allow the area to dry completely. (Even if the area appears to be dry sooner, wait at least one full minute before venipuncture is performed.)
8	Prepare the culture bottles for inoculation and wipe the tops with a sterile alcohol pad.
9	Apply a tourniquet, being careful not to touch the prepped area with gloves or tourniquet.
10	Perform phlebotomy by using the needle and syringe. (A 20-ml portion of blood per set of cultures is recommended for adult patients.)
11	Directly inoculate the blood culture bottles by using the same needle used to perform the phlebotomy (i.e., do not change needles). Note: if a blood sample is drawn at the time of placement of a new intravascular catheter or at the initiation of hemodialysis through a graft or fistula, prepare the skin as described above and draw the sample through the catheter into a syringe. Using aseptic technique, place a sterile needle on the syringe and inoculate the culture bottles.
12	Dispose of the needle and syringe in the appropriate sharps container.
13	Send the blood samples to the lab by the standard protocol. No special handling or labeling is required for this study.
14	Use an alcohol pad (or pads) to wipe the prepped area until none of the color from the skin prep remains (i.e., the white alcohol pad should remain white after rubbing). (Note: not all of the skin preparations will discolor the skin, but wipe the area with an alcohol pad anyway.)

^aWhen a blood culture is ordered, this procedure should be followed. It is generally recommended that two sets of blood cultures be obtained from two different sites in the evaluation of any new fever.