Therapeutic Phlebotomy Via Vascular Access Device (i.e. mediport, PICC line, central)

Always_Learning, BSN, RN · Jul 11, 2011

The Infusion Nurses Society has some information I've read about the role of nurses with PICC lines, etc. While I haven't explored all of their info by any means, if you research their website and published papers, they might have something that would help you.

KayRN910 · Jul 11, 2011

I'm not sure about actual P&P for my hospital, but I can tell you what we do in my ER...

We will access a Mediport if we just have to. Our biggest reason is because of risk for infection - every time you access that Mediport, you are opening your patient up for an infection in the blood. Plus, the blood can clot or the mediport wont draw at all (which happens!) then you've just done it all for nothing.

PICC lines, well, that isn't such a big deal. We just scrub really really good with alcohol for at least 15-20 seconds before doing it.

You may find this thread helpful...

https://allnurses.com/nursing-issues-patient/drawing-blood-picc-30490.html

morte, LPN, LVN · Jul 12, 2011

I am a nurse extern working in an infusion center. We have a few patients who need therapeutic phlebotomies, however, they do not have good peripheral veins. I was just looking for any information in regards to using a mediport, PICC line, or central line for the therapeutic phlebotomy. Does your medical facility have a protocol in place? Do you know of any research in which would help us get one in place?

are you refering to hemochromatosis? If so we are talking about basically draining a pint of blood, yes?

blondy2061h, MSN, RN · Jul 12, 2011

I'm not sure about actual P&P for my hospital, but I can tell you what we do in my ER...
We will access a Mediport if we just have to. Our biggest reason is because of risk for infection - every time you access that Mediport, you are opening your patient up for an infection in the blood. Plus, the blood can clot or the mediport wont draw at all (which happens!) then you've just done it all for nothing.
PICC lines, well, that isn't such a big deal. We just scrub really really good with alcohol for at least 15-20 seconds before doing it.
You may find this thread helpful...
https://allnurses.com/nursing-issues-patient/drawing-blood-picc-30490.html

Accessing a PICC is no less risky infection wise than accessing a mediport. They're both central blood sources. If you use proper technique you should be fine. If a patient has central access, it's often because they have poor peripheral access. Don't waste what peripheral veins they have left if you don't need to, as some things can only be done peripherally.

Nurse_Extern · Jul 12, 2011

Yes, we have many Hemochromatosis pt that have poor peripheral veins. I have done a lot of research about mediports, PICC lines, and Central lines. I know how to safely access all three. I am trying to find out if other medical facilities are using the devices to do the therapeutic phlebotomies and if they have a protocol in place for it.

chemosafe · Nov 14, 2011

Did you find anything out about your question? I actually am looking for the same thing at our facility.

mamacita867 · Nov 15, 2011

I have also completed therapeutic phlebotomies via a mediport although not recommended by the INS standards (the patient did not have a peripheral site for the procedure). We are also questioning if any vascular access teams are also using central line access for this procedure?

mamacita867 · Nov 15, 2011

Do you have a protocol in place at this time for this procedure using a central line?

Nurse_Extern · Jan 10, 2012

We don't currently have a policy in place; but through research with various manufacturers, I have found you can safely remove the amount needed for a therapeutic phlebotomy using the protocol for lab draws.

countryliving · Mar 14, 2012

I have Hemochromatosis and I don't have veins left for the phlebotomy. We have tried many things I had a dialysis shunt for 5 months while getting weekly phlebotomy. I am on my third mediport (they last 4 to 5 years) which is now acting up so will probably be looking at my 4th one. Not sure how many other people go this route. I have been doing treatments since 1999.

Any suggestions on new ideas?

primarylovin · Nov 14, 2018

i work in an outpatient infusion center, primarily chemotherapy, but we do some non chemo's and therapeutic phlebotomies through mediports. we have a policy and procedure in force. i understand that using a mediport according to package insert is off label. therefore most organizations have no position papers on this procedure. but when your patient becomes peripherally challenged, one has to weigh the need. that being said, our policy calls for the use of a stopcock, to minimize interruption in the line. we use a 500 ml pooling flask (vacuum packed), centesis set, stopcock and 19 gauge huber needle. a newer employee has eliminated the use of the stopcock and if she has to flush the line, she disconnects the tubing and flushes. my brain says minimize the open manipulation of a line. what do the rest of nurses do when your only option is a mediport.