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Thu, 05/10/2007 - 13:35
#1
brendan
therapeutic phlebotomy
We had an order to do a therapeutic phlebotomy (500cc) for iron overlaod through a mediport.  The INS standards state (S72)that implaned ports, piccs tunneled catheters should not be used for therapeutic phlebotomy.  Does anyone know the rationale for this contraindication? Thanks in advance for your help.
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Thu, 05/10/2007 - 15:43
anna liang
Will worry about the risks
Will worry about the risks of the clotting up the port during the procedure.

Also if clots form during the procedure inside the port/port lumen, you can easily flush them back into the blood stream since you can't see clots inside the port.
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Mon, 05/14/2007 - 15:38
lynncrni
The patients blood will be
The patients blood will be extremely thick and viscous, requiring a very large catheter lumen or port needle. While this has been done, it has not risen to the level of being a standard of practice yet, not anything published yet about outcomes. There is the increased risk of loosing the patency of the catheter while doing this procedure. Also, fluid flows slower through a longer tube. So add the length of the catheter to the viscosity of the blood and your success rate with completing the procedure drops dramatically. 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

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Thu, 05/17/2007 - 23:25
lisayrn
Lisa Y., Team Leader IV Team

Lisa Y., Team Leader IV Team UPMC St. Margaret Pittsburgh

We had a physician who wrote an order for us to perform therapeutic phlebotomy through an artline when a peripheral stick was impossible.  YIPES!

Has anyone ever heard of this?  We refused, but he talked an ICU nurse into doing it when we left the unit. 

Lisa Y., RN, BSN University of Pittsburgh Medical Center/Horizon IV Therapy

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Tue, 05/22/2007 - 04:49
Nancy Leland
We also had an order to do a
We also had an order to do a phlebotomy through a portacath.  I worried about the vacuum of the evac bottle, and its effect on the port.  INS standards do not allow this to be done, so we refused, based on this evidence.  I was also concerned about the removal of 500cc of blood so quickly from a vessel just outside the right atrium.  I do not know if this was a valid concern, and could not find any literature about this.   
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