Phlebotomy thru port?

  1. Has anyone out there ever had this experience? We have a pt needing regular therapeutic phlebotomies but no veins! Dr. suggests a port but
    we've never heard or read anything...please advise
  2. Visit rusty55 profile page

    About rusty55

    Joined: Jul '08; Posts: 2


  3. by   iluvivt
    Yes we have done this many times. If you choose to do it this way you may have to get a little creative depending upon the type of equipment you have available. We have to get large syringes (60 ml) and use thos to withdraw the blood. We have a standard phlebotomy bag with an attached 16 gauge needle on it. I would not want to use a vacutainer system on a port. Just respect the port...scrub well and perform a good pulsatile flush when you are done and prn to keep the blood coming.
  4. by   rusty55
    Thank you for the info, I didn't get a visual on the phlebotomy bag with needle, how do you transfer blood into bag? We've done a peripheral draw with 60ml syringes and just disposed the syringes. Do you happen to have a written procedure? New to this site so I hope this goes out to the responder...Thanks
  5. by   iluvivt
    I am talking about just doing a regular phlebotmy when the patient has no CVC. or even if they do you can still do it this way. In cases where pt has any CVC you are not obligated to use it. The bag is just a standard blood collection bag with a long iv tubing the end of the IV tubing is a capped 16 gauge needle. So you perform your venipuncture with the stell needle ...tape it down....then open the roller clamp....lower your collection bag....and blood will filll into the bag. there is also a vacutainer method. Yes I can e-mail you our policy if my hospital does not block it. it usually lets me do it/ Send me a private message and I will send you our phlebotomy protocol. Any More questions...ket me know.
  6. by   PICC ACE
    You can "unofficially" do a phlebotomy from a CVC,PICC or port by withdrawing the blood using a syringe to do so,but you should be sure to check with your manufacturer first as these devices are not specifically designed for therapeutic phlebotomy. I looked into this a while back and received confirmation from two companies (Bard and Arrow) that doing Ther. Phlebotomy with their devices was "off label" use and as such you do so at your own risk.
  7. by   iluvivt
    Yes I know what you are saying but if your back is up against the wall ,what are you going to do.You look at the risk vs the benefit,and clearly if the patient needs the phlebotomy and that is the only way to achieve it go for it. So instead of drawing 10 ml blood for sampling you draw 500 ml off...the procedure is basically the same...just keep the blood moving...and if need be periodically stop and flush.
  8. by   eernuts
    In my institution, the lab does the therapeutic phlebotomy and my nurses who work in pre-admission testing (of all places) monitor the patient. I want my PAT nurses doing PAT work. Forgive my ignorance, but does a nurse have to be present for therapeutic phlebo?
  9. by   accessqueen
    I would want a nurse to be, if not present, then immediately available. We have had, on more than one occasion, patients vasgo-vasal and completely pass out.
  10. by   RNONC3048
    Does anyone know if their BON has ruled that Theraputic Phlebotomy via a VAD/Port is outside RN Scope of Practice?? NH has--
  11. by   gcuprak
    My hospital at Cody Wyoming does these all the time. 500 ml blood is taken from pt through port access using a 19 gauge huber needle ( any smaller clots). a three way stop valve is attached to the needle and extention line. a 10 ml syringe or larger is attached to one valve and a regular phleboltomy bag is attached to the bottom valve via a buffalo cap. Blood is drawn off the pt into the syringe and then pushed into the phlebotomy bag. This continues untill the desired amount is drawn off. about every 100 ml of blood, I find it helps to flush with 10 ml NS and then 5 mls of heparin. A steady flow of in and out is needed to keep the blood from clotting.
  12. by   tmhop
    The Standards of Practice by INS (Infusion Nurses Society) 66.III.B state that ports should not be used for therapeutic phlebotomy.

    /Tess M. Hopkins
  13. by   gcuprak
    This may be true but in cases of hemachromatosis, and pt with weekly phlebotomies a port is a great thing and is used by Utah state university hospital clinical research dept to drain pts without using the hard to find, over used viens. I personaly have been using my port for the last 8 years to do theraputic phlebotomies, and it has saved me not only from poke after poke to find scared viens but probably saved my life because I was able to become de-ironed. Which took 3.5 years to bring my ferritan levels from 6500 to 75
  14. by   phymsa
    Quote from rusty55
    Has anyone out there ever had this experience? We have a pt needing regular therapeutic phlebotomies but no veins! Dr. suggests a port but
    we've never heard or read anything...please advise
    I know this is an old posting, but we just did one today. Most of our patients have ispMRI Powerports from Bard, and I called the Bard customer service representative who was not aware of any published materials on phlebotomy per port but based on customer reports and recommendations re lab draws, etc, recommended:

    1. Use syringes larger than 10 cc; preferably larger than 20 cc.

    2. Set up a 3- way stopcock. Stop the phlebotomy and flush the port periodically during the procedure (I would assume this is particularly important for patients with erythrocytosis because of the viscosity and increased thrombosis risk)

    My suggestions:
    3. Probably shouldn't put in a dual-lumen port for this - the individual ports are usually smaller. (This is my comment.)

    4. Use the same non-coring access needle you would usually use for the specific port; larger gauges preferred.

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