血培养标本采集

血培养标本采集 血培养标本细菌学采集、运送、验 收#操作# 1(目的 血培养标本细菌学采集、运送、验收标准操作规程～确保检验结果准确可靠。 2. 范围 微生物实验室受理血培养瓶。 3. 职责 3.1 医护人员正确采集血培养标本送检。 3.2 临床科室标本运输人员负责及时将血培养标本送至检验科微生物室。 2血培养指证 2.1患者出现寒战～发热,?38?,或低温,?36?,. 92.2白细胞增多,,10×10/L～特别有“核左移”未成熟的或带状的白细胞增多,皮肤粘膜出血,血液病患者出现粒细胞减少,成 9熟的多形核白细胞<1×10/L,～血小板减少等. 2.3怀疑血流感染时～医院内肺炎. 2.4留置中心静脉导管超过72h. 2.5感染性心内膜炎、骨髓炎、昏迷。 2.6有严重基础疾病、免疫缺陷伴全身感染症状、多器官衰竭。 2.7临床医生怀疑有血流感染可能的其他情况.,血压降低～CRP升高及呼吸快,。 2.8新生儿菌血症～应同时做尿液和脑脊液培养。 3血培养采集 3.1采集血量:采血量以培养基的 1/10 为宜～成人每瓶采集: 5，10ml,婴儿每瓶采集:1，2ml。儿童每瓶采集:2，5 ml。婴幼儿病人～一般只抽一瓶需氧瓶进行培养～无需常规做厌氧瓶。 3.2血培养份数和采血时间 3.2.1对怀疑菌血症的成人患者～推荐同时采集2-3套,不同部位,血培养标本。婴幼儿患者～推荐同时采集2次,不同部位,血培养标本。一次静脉采血注入到多个培养瓶中应视为单份培养或一套血培养。多次采血不应在同一部位进行～应更换部位。对coupling Centre shall be checked, the second poured concrete strength of more than 70%. In the process of reaming or boring, apart from the special provisions in factory, does not allow any work that may affect the coupling Centre, such as irrigation, to cylinder connections to flood the condenser pipes and so on. Well boring, hinge bolt hole flange with coupling of vertical, not oblique. Mounting bolts should be added lubricants, typing gently with a small hammer, not too loose or too tight, packed the bolts with the corresponding seal screw hole should be marked. 6.4.5.4.2 coupling reamed and pairings is close to the diameter of bolt bearing good hinge holes, dressed with a good two coupling bolts before you can move the rotor, boring-reaming hole in turn. Coupling bolts must be tight coupling is symmetrical diameter, in boring, reaming, two bolts out. Well boring, hinge bolt hole flange with coupling of vertical, not oblique. Due to the coupling bolts in accordance with hinge holes corresponding to the diameter of the screw holes one by one after processing, processing back bolt installation location cannot be changed, so according to bolt after the actual weight difference of nut and lock washer to match. General requirements for coupling two symmetrical diameter bolt, nut and lock washer's total weight difference should not be greater than 10 g and knocks stamped mark. (See Figure 18) The coupling bolts apply lubricant, and then gently with copper home, not too loose or too tight. Bolt Assembly is finished, symmetrical tightening all bolts to 30%, 50%, 70%, 100% force, and check the coupling flutter and before connecting the circle gradually changes its value should be less than 0.02mm. Tightening torque of the coupling bolts shall comply with the technical requirements manufacturers drawings, with a dynamometric wrench or log tension tools. Three wheel rotor swing test coupling connections should be checked: taking leave, 于间歇性寒颤或发热应在寒颤或体温高峰到来之前0.5-1小时采集血液。对于某些全身性和局部感染患者采血培养的建议:,一瓶需氧瓶～一瓶厌氧瓶为一套～或者两套需氧瓶为一套, 3.2.2急性发热怀疑菌血症者～应尽量在抗菌药使用之前～在10分钟内于不同部位采集两套血培养标本。 3.2.3对于非急性感染～怀疑有菌血症者～应在24h内于不同部位采集2-3份血标本～每次采血的间隔不应小于3h～并应于抗菌给药前采血。 3.2.4急性细菌性心内膜炎患者～应在1-2小时内采集3份血标本～并尽量在抗菌药前采血,如果24小时培养阴性～可再采集3份以上的血标本。入院前两周内接受抗菌药物治疗的患者～连续3天～每天采集2份。可选用中和或吸附抗菌药物的培养瓶。 3.2.5亚急性细菌性心内膜炎患者～在24小时内不同部位采集血液标本2或3份～每次间隔大于1h,如果24小时培养阴性～可再采集2或3份以上的血标本进行培养。 3.2.6不明原因发热～可在24小时内不同部位采集血液标本2或3份～每次间隔大于1h,如果24~48小时培养阴性～可再采集2或3份以上的血标本。 3.2.7可疑菌血症或真菌菌血症～但血培养持续阴性～改变血培养条件和方法～以获得罕见的或苛养的微生物。 3.2.8儿童菌血症患者在24小时只需要采一次血标本进行培养～需特别注意穿刺部位的消毒～以区别感染菌和污染菌～由于儿童厌氧菌菌血症罕见～常规血培养不做厌氧培养。 3.3血培养瓶类型: 3.3.1蓝色:成人需氧血培养瓶。 3.3.2结红色: 成人厌氧血培养瓶。 3.3.3黄色:儿童需氧血培养瓶。 3.4采血操作流程 3.4.1.手卫生:七步洗手后手消毒。 3.4.2.血培养瓶消毒:根据检验申请单～选择合适的血培养瓶～检查血培养瓶有无破损、保质期等。用75%酒精消毒血培养瓶塞～作用60s～待干。 coupling Centre shall be checked, the second poured concrete strength of more than 70%. In the process of reaming or boring, apart from the special provisions in factory, does not allow any work that may affect the coupling Centre, such as irrigation, to cylinder connections to flood the condenser pipes and so on. Well boring, hinge bolt hole flange with coupling of vertical, not oblique. Mounting bolts should be added lubricants, typing gently with a small hammer, not too loose or too tight, packed the bolts with the corresponding seal screw hole should be marked. 6.4.5.4.2 coupling reamed and pairings is close to the diameter of bolt bearing good hinge holes, dressed with a good two coupling bolts before you can move the rotor, boring-reaming hole in turn. Coupling bolts must be tight coupling is symmetrical diameter, in boring, reaming, two bolts out. Well boring, hinge bolt hole flange with coupling of vertical, not oblique. Due to the coupling bolts in accordance with hinge holes corresponding to the diameter of the screw holes one by one after processing, processing back bolt installation location cannot be changed, so according to bolt after the actual weight difference of nut and lock washer to match. General requirements for coupling two symmetrical diameter bolt, nut and lock washer's total weight difference should not be greater than 10 g and knocks stamped mark. (See Figure 18) The coupling bolts apply lubricant, and then gently with copper home, not too loose or too tight. Bolt Assembly is finished, symmetrical tightening all bolts to 30%, 50%, 70%, 100% force, and check the coupling flutter and before connecting the circle gradually changes its value should be less than 0.02mm. Tightening torque of the coupling bolts shall comply with the technical requirements manufacturers drawings, with a dynamometric wrench or log tension tools. Three wheel rotor swing test coupling connections should be checked: taking leave, 3.4.3.皮肤消毒:按常规消毒穿刺部位皮肤(用70%酒精檫拭静脉穿刺点为中心向外螺旋式消毒穿刺部位皮肤作用60秒以上。再用10%碘伏以穿刺点为中心向外螺旋式消毒穿刺部位皮肤作用60秒～同时旋转棉签～保证穿刺点及周围皮肤无菌状态～防止皮肤寄生菌或环境引起的污染)～消毒范围为8×10cm～待干。 3.4.4(持穿刺针按常规方法刺入静脉～另一头刺入相应血培养瓶内～利用瓶内真空抽取血标本～如用注射器无菌穿刺取血后,勿换针头直接注入血培养瓶。 3.4.5(建议每套血培养同时接种至需氧瓶和厌氧瓶～有利于微需氧菌和厌氧菌的检出。当厌氧菌感染不能除外的病人～如腹部手术合并感染的病人～必须同时做厌氧菌血培养。 3.4.6如果不能满足推荐的采血量时～应首先满足需氧瓶, 3.4.7血液注入血培养瓶后轻摇瓶子以防血液凝固。 4运送要求 4.1所有标本采集后都应立即送往实验室～最好在2h内。如果不能及时送检～宜置于室温环境。血培养瓶送到检验科放入培养箱前～禁止暂存于冰箱内。 4.2送检标本应正确标注相关信息～注明采样时间和送检时间。4.3安全防护:放标本的容器必须防漏～禁止将渗漏的标本送往实验室。 5拒收不合格血培养: 5.1检查培养瓶是否有渗漏、破损或明显污染,注意采血量不足或过多情况。 5.2检查瓶子上的标签与申请单是否相符,并在申请单上注明采血量～抗生素使用情况以及采血部位,如静脉、导管, 5.3对于延迟送检的血培养瓶应注意肉眼观察微生物生长可视信号～如发现可视信号提示有微生物生长～应该立即直接涂片镜检和划线转种。 6注意事项 6.1检验单需注明抗菌药物使用情况、血液采集时间和部位、临床诊断等患者信息。 6.2采血部位通常为肘静脉～疑为细菌性心内膜炎时以肘动脉或股动脉采血为宜～切忌在静滴抗菌药物的静脉处采血。除非怀疑有导管相关的血流感染～否则不应从留置静脉或动脉导管取血因为导管易被皮肤正常菌群污染。 coupling Centre shall be checked, the second poured concrete strength of more than 70%. In the process of reaming or boring, apart from the special provisions in factory, does not allow any work that may affect the coupling Centre, such as irrigation, to cylinder connections to flood the condenser pipes and so on. Well boring, hinge bolt hole flange with coupling of vertical, not oblique. Mounting bolts should be added lubricants, typing gently with a small hammer, not too loose or too tight, packed the bolts with the corresponding seal screw hole should be marked. 6.4.5.4.2 coupling reamed and pairings is close to the diameter of bolt bearing good hinge holes, dressed with a good two coupling bolts before you can move the rotor, boring-reaming hole in turn. Coupling bolts must be tight coupling is symmetrical diameter, in boring, reaming, two bolts out. Well boring, hinge bolt hole flange with coupling of vertical, not oblique. Due to the coupling bolts in accordance with hinge holes corresponding to the diameter of the screw holes one by one after processing, processing back bolt installation location cannot be changed, so according to bolt after the actual weight difference of nut and lock washer to match. General requirements for coupling two symmetrical diameter bolt, nut and lock washer's total weight difference should not be greater than 10 g and knocks stamped mark. (See Figure 18) The coupling bolts apply lubricant, and then gently with copper home, not too loose or too tight. Bolt Assembly is finished, symmetrical tightening all bolts to 30%, 50%, 70%, 100% force, and check the coupling flutter and before connecting the circle gradually changes its value should be less than 0.02mm. Tightening torque of the coupling bolts shall comply with the technical requirements manufacturers drawings, with a dynamometric wrench or log tension tools. Three wheel rotor swing test coupling connections should be checked: taking leave, 6.3采血次数:对于成年患者～应该同时分别在两个部位采集血标本～在两个部位分离到同样菌种才能确定时病原菌。 标本采集和运送均应在防止污染的原则一下认真进行。 6.4 当怀疑骨髓炎、脑膜炎、肺炎和肾盂肾炎合并菌血症时～在抗菌药物使用前从不同部位抽取2套血培养～两个来源的采血时间必须接近,建议?5分钟,～各自做好标记。 6.5对不明原因的发热、亚急性心内膜炎～由三个?同的部位抽取3套血培养～每套间隔时间?1小时～当培养24，48h后若为阴性～则继续采集2套血培养。 6.6导管相关血流感染: 6.6.1希望保留深静脉导管者 至少采集2套血培养～其中至少一套来自外周静脉～另一套从导管采集～两个来源的采血时间必须接近,建议?5分钟,～并各自做好标记。 6.6.2决定拔除深静脉导管者 从独立的2个外周静脉部位～无菌采集2套血培养～同时无菌下取出导管并剪下5cm导管末梢送实验室。 coupling Centre shall be checked, the second poured concrete strength of more than 70%. In the process of reaming or boring, apart from the special provisions in factory, does not allow any work that may affect the coupling Centre, such as irrigation, to cylinder connections to flood the condenser pipes and so on. Well boring, hinge bolt hole flange with coupling of vertical, not oblique. Mounting bolts should be added lubricants, typing gently with a small hammer, not too loose or too tight, packed the bolts with the corresponding seal screw hole should be marked. 6.4.5.4.2 coupling reamed and pairings is close to the diameter of bolt bearing good hinge holes, dressed with a good two coupling bolts before you can move the rotor, boring-reaming hole in turn. Coupling bolts must be tight coupling is symmetrical diameter, in boring, reaming, two bolts out. Well boring, hinge bolt hole flange with coupling of vertical, not oblique. Due to the coupling bolts in accordance with hinge holes corresponding to the diameter of the screw holes one by one after processing, processing back bolt installation location cannot be changed, so according to bolt after the actual weight difference of nut and lock washer to match. General requirements for coupling two symmetrical diameter bolt, nut and lock washer's total weight difference should not be greater than 10 g and knocks stamped mark. (See Figure 18) The coupling bolts apply lubricant, and then gently with copper home, not too loose or too tight. Bolt Assembly is finished, symmetrical tightening all bolts to 30%, 50%, 70%, 100% force, and check the coupling flutter and before connecting the circle gradually changes its value should be less than 0.02mm. Tightening torque of the coupling bolts shall comply with the technical requirements manufacturers drawings, with a dynamometric wrench or log tension tools. Three wheel rotor swing test coupling connections should be checked: taking leave,