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Phlebotomy through port : help please



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Oct 20, 2008 09:08 PM

Phlebotomy through port : help please


I felt the need to start a new thread on this subject because I am a recipient of a CVC that was supposed to have been installed SPECIFICALLY
for therapeutic phlebotomy.

The first 3 attempts to access it in the manner in which "they" intended it to be used failed .

I have an Internal specialist , and a surgeon at a major medical facility

I was given a double lumen Bard Access Systems CVC.
Product code: 0607655
http://www.bardaccess.com/

I called the manufacture they said QUOTE :

The model implanted in me is not advertised to
support therapeutic phlebotomy. Phlebotomy with their devices was
what they termed " Off Label" and if used for such you do so at your
own risk.
They went as far to say that the choice of my port was particularly
poor choice for ther. phleb. being a double lumen, and suggested it should never have been put in me for this application and someone
on the staff should have known.

What do you think about the way my case was handled ?
What should I do ?????


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5 Comments
No. 1
Old Oct 20, 2008, 11:49 PM

Default Re: Phlebotomy through port : help please
I have performed phlebotomy thru a port on several occasions and you can't pull thru gravity in the traditional sense you must pull thru a syringe.
what I do is to use several large syringes either #10 50 ml syringes or whatever you have on hand to equal 500 ml.
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No. 2
from iluvivt
Old Oct 21, 2008, 05:06 AM

Default Re: Phlebotomy through port : help please
I too have seen ports placed for this very reason...even if it is an off-label use. Do not let the term off label use scare you. Drugs are prescribed all over the world for off label uses. I spend a huge part of my home health career giving IVIG as an off label use. In performing a therapeutic phlebotomy using a port I usually get some 60 cc syringes and then keep the blood flowing. If it gets sluggish I may stop and flush well and then proceed and make sure they perform a good push pause pulsatile flush and at least 10- 20 ml of NS to really clear the blood from the line. Heparin is used as a final flush in most situations. I would not use any type of vacutainer system,but a simple gravity bag can be used. Of course, you are aware that a special non-coring needle needs to be used for the port access and in your situation they should use at least a 20 gauge,though I usually use a 19 gauge. Different hospitals carry different products,but the use of a 22 gauge will make it a bit difficult to get large quantities of blood out easily and keep clotting at bay. Please remember that the manufacturer does not always know what is best for an individual patient. What are your other options....let me tell you ...not great.... a port and a PICC have the lowest infection risk of all the venous access devices and the port is easier to live with on a long term basis (over years). Your other option is to keep getting poked and eventually you will have venous damage and scars, not to mention the pain.
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No. 3
Old Oct 21, 2008, 07:04 AM

Default Re: Phlebotomy through port : help please
Thanks for the advice, you've made me feel a lot better,

I'm pretty sure you are correct. I never realized what it really takes to get 500ml of blood out of the body, it stinks cause it has to be one syringe at a time but after spending 2 hours on the table yesterday it seems like it would be an improvement.
2hrs = 200ml with a vacutainer, I don't think it will ever work.
I have already been told with my condition my blood is already predisposed to clot and trying to drop that amount through such a long small bore line is a waste of time.
The RN had no problem pulling a full 20 cc syringe full out of my port even with a 20ga needle .
The procedure you suggest to me seems like it could be performed in 30 to 40 minutes with a little practice, is that accurate ?

Thanks
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No. 4
from iluvivt
Old Oct 22, 2008, 01:29 AM

Default Re: Phlebotomy through port : help please
To Reynolds 24a, if they have everything ready and prepared you can easily draw off 500ml in about 15 minutes. I had to draw off 400 ml the other day with syringes from a peripheral stick b/c we ran out of the blood transfer bags and it took me about 20 minutes with another nurse handing me a new syringe every time I needed one. Just remember that accessing the port is a sterile procedure and make sure they use at least a 20 gauge. Also the skin over your port will become desensitized over time and you will not feel the poke as much. If it gets too annoying ask MD for some LMX cream to apply before the puncture...it works faster than Emla cream. Remember if the draw gets sluggish do not hesitate to ask the nurse to stop and flush your line and then they can resume the withdrawal. Do not be afraid to be proactive and protect your port...make sure the nurse performs hand hygiene b/f working with your port and that it gets flushed properly etc. Monitor for any complications such as fever,chills ,pocket infection,arm swelling, pain in your armpit,face jaw.or a pronouned venous pattern on your arm or chest. Hope this helps and keep us posted about how things are working out for you!!!
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No. 5
from jb2u
Old Oct 23, 2008, 12:13 PM

Default Re: Phlebotomy through port : help please
Closed. This falls under...seeking legal/medical advice.
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