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Elizabeth.Raucci
Therapeutic Phlebotomy via dialysis needles in graft/fistula

Is anyone aware of evidence based literature regarding Therapeutic Phlebotomy via dialysis needles in either a fistula or graft?  Having a hard time substantiating this as a poor choice to our nephrologists and would welcome any citations or information.  Thank you.

pfintonis
I am unaware of any evidece

I am unaware of any evidece for the practice, I imagine that there havn't been any studies on the practice. While I'm not a dialysis specialist, it seems reasonable in some situations. If the patient is Very limited in access, and is a Very difficult draw, and the equipment is appopriate for the device(Dialysis needle; dialysis fistula), and it is performed by a dyalysis competent nurse , then I don't see what the negitive outcome would be from the practice. If there were a less invasive alternitive, than I would prefer it, and depending on the availibility or access to a dialysis RN and the reimbursment implications, it may be prohibitive. If it is an active dialysis patient, could it not be done during dialysis? I don't know enough about the equipment to know if that is possibility. If not, then prior to initiation of treatment seems resonable. (no need to reaccess, just pull off 450ml blood before connecting to machine). I remember a time when we ordered to phelbotomize a patient stat. We didn't have access to the blood bank equipment at the time, so we drew with a 21g butterfly in the AC 45 gold top tubes(10cc each)

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