Phlebotomy through port : help please

gardengirl63 · Oct 21, 2008

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.

iluvivt, BSN, RN · Oct 21, 2008

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.

reynolds34a · Oct 21, 2008

Thanks for the advice, you've made me feel a lot better, :yeah:

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

iluvivt, BSN, RN · Oct 22, 2008

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!!!

jb2u, ASN, RN · Oct 23, 2008

Closed. This falls under...seeking legal/medical advice.