Does anyone have any advice as I have a pt who needs monthly phlebotomies. I have seen her three times now. She is 90 lbs soaking wet, has one tiny anticubital vein she will allow me use. She has poor veins. The bag fills slowly and when it get about half way full the flow stops. I pull the needle out and there is a clot that pulls out also. I am guessing the flow is so slow that the blood clots in the needle. This is over a 5-10 minute procedure. I do these procedures often and don't have this problem with other pts. This pt is in her 70's, heavy smoker, poor health and states she has had to undergo phlebotomies for many years. She also states the vein she allows me to use is the only one that will work.
Are you talking about a therapeutic phlebotomy? What volume are you withdrawing? What is the patient's diagnosis? Do you have a system where saline can be injected to keep the blood flowing. Patients with polycythemia have such thick viscous blood flow that frequent flushing with saline is required to get the total amount of blood withdrawn. Since this patient is a heavy smoker, she is hypercoagulable even with a diagnosis of polycythemia. Monthly venipunctures in the same vein will soon result in so much scarring that it will not longer be accessible and that may be causing some of the problem now. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Yes this is a therapeutic phlebotomy. I beleive all her A/C veins have been scarred already. She is a new pt for our small center. I am going to get more research on her case and I will get back to you . I only have access to a blood donor set for the phlebotomies that we do and there are no ports for saline flushing. That sounds like that would solve my problem. How do I order a set like that? We mostly do Home IV Antibiotic teaching at our clinic. We usually only see 3-4 of these pts a year! The total volume . goal is approximately 500cc's.
The pt has Hemachromatosis
How do I find this system where I can periodically saline flush?
One brand was shown at INS this year but I don't remember the na
E. Maybe someone else does. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
What size needle/catheter are you using? What type of system?
Kathleen Wilson, CRNI
A blood donor set.
Ok, then you are using a 16 g?
Email me and leave your number, and I will call you: [email protected]
Kathleen Wilson, CRNI
I worked in an outpatient infusion room for 22 years. I have done hundreds of phlebotomies. There was one patient that I could not perform a phlebotomy on, which also came in three weeks in a row, and each time I was unsuccessful. The physician sent the patient to have a graft made like they do for dialysis patients. I thought the physician was being overly agressive, but it actually worked very well. I just placed the needle into the graft. Of course I needed to hold pressure on it a lot longer than a normal venous access. I think they were acting agressively because the patient's liver was failing from the hemachromatosis. Good luck!
WOW, That is very interesting information. Thank you.
You can always consult at emt classes orange county, surely they can help you with regards to this matter.
I also work in an outpatient clinic. We have had a few patients over the years with this problem. One of the things we have done is to access the patient with an 18 ga angiocath. We used to use Abbott but are currently using BD Nexiva catheters. We use the older, not needle less, caps on the end of the catheter. Then you will be able to insert the blood bag needle into the cap and allow the blood to drain. When the drainage starts to slow down, we are able to remove the needle and flush the line with some saline, which usually helps it to flow again.
We also had a couple of patients with Polycythemia Vera that the doctor would actually order us to give them a bolus of 250-500 mls of saline via the 18 ga catheter prior to doing their phlebotomy. This definitely helped the phlebotomy to drain better.
We also encourage our patients to drink plenty of fluids prior to their phlebotomy (as long as their doctor has not restricted their fluids), and advise them that this can help us to be able to drain their blood more easily.
I hope this is helpful to you.
I applaud your creativity with this system but I have some serious reservations about its use. I know the Nexiva has the built-on extension while other catheters do not. Regardless of which one you are using, I would need to know what size is the needle on the end of the blood set? Also how long is it? I assume you are referring to a sharp beveled needle designed for venipuncture. The outer diameter of this needle could easily be too large for the inner diameter of the catheter or extension. The length could easily extend into the extension set on the Nexvia or the catheter lumen on other brands, damaging this device. This would be akin to reinsserting the stylet into the catheter. All catheter manufacturers state NOT to do that. Is this needle permanently fixed on this set? Is there a set avaialble where this needle is not permanent? If so, I would definitly choose the one that could be removed. The needle inside the catheter lumen would have to be smaller than the catheter. This means that blood is flowing from a large pipe (catheter) into the small pipe (needle) and this needle would act to restrict the blood flow. A direct luer locked connection would be better. Additionally, how do you maintain the sterility of that needle once it is removed from the injection cap so that you can connect again? These are single use only devices, so if it is permanently fixed it could not be changed for a second insertion through the cap. What is done with it while you are flushing, etc.to prevent it from being contaminated? I have done therapeutic phlebotomies on many patients in the past and never found the need for such a system. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861