I have a colleague who is in charge of the OP department; this is where they do OP infusions, theraputic phlebotomies etc.... Basically they had a patient who had been to other facilities and to their unit once for a theraputic phebotomy, they were unable to access a vein at that one time and were therefore unable to perform the Theraputic phlebotomy. Then, on there own the physician who ordered the phlebotomy, without our knowledge, referred the patient for a port to have the phebotomies done via the port. so, the surgeon inserted the port.
We found out about it when the physicians office called back up to schedule the pt appt for phlebotomy. We began to research and basically find out that the INS says that using a port for theraputic phlebotomy should not be done. We are aware it has been done in some settings but.....bottom line is that the INS; who sets the standard , does not recommend it. They are the decision makers for legal references etc.... We collected all data and presented it to our surgeon and Director of Surg, who is over the OP department. At first they were like; thats ok, you can still do it , it will be fine. If the catheter clots off you just fix it with Cathflo like usually. They want to keep the pt and the surgeon and MD happpy.
We told them that this is not a practice that needs to be done. We reviewed how we practice evidence based medicine and there is currently no proof, outcomes, standards etc sayinig this is safe. We realize it may sound perfectly fine and safe but it has not been proven such. If we start doing something that is not recommended and we are even told "should not" by INS we dont have a leg to stand on if issues arise. Basically we are saying this is something we will not be doing; that this is not in the best interest for the patient to practice this way. surgeon should have looked into this a little more before doing the Port, and maybe put in an apheresis cath or something I read about.
Medical doctor doesnt understand; says why not , if I write and order you should do it. :) Any way, I told her, the OP Director, to go talk to our Risk Mgmt director and explain to the her what is currently being debated. Now the medical Doc is going to talk to pt OOT oncologist.
Any recommendations? thanks, Gina Ward, R.N, CPAN, PICC nurse at Raulerson Hospital