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Therapeutic Phlebotomy

Was wondering for those of you that are involved with therapeutic phlebotomy what you do when you are unable to access a vein with a 14 gauge needle.  Our hospital is working on an algorithim for those difficult patients that cannot handle a 14 gauge needle.  Does anybody insert a smaller gauge say an 18 and draw the blood off with 60cc syringes?  Do any of your institution place hemo catheters and use phresis, if so in what cases? INS Standards states not to use a PICC, midline, tunneled catheters or ports so what are other alternatives that work.

Thank you

Robbin George
For the past few months we
For the past few months we have done weekly Therapuetic Phlebotomy on a patient and was told from the beginning that treatment might continue for as long as one year --[The patient had a fainting episode in the MDs office the first time the procedure was done so she is admitted to a Telemetry bed]--We start a 22g SL, draw Labs and then infuse fluids for 30 mins prior to withdrawing 300-500mLs Blood by inserting a 20g Butterfly in the opposite AC using US guidance--We continue to infuse IV fluids for 90 minutes post procedure while she is monitored--She comes in after work so she usually spends the night--I have done humdreds of Therapuetic Phlebotomies in the past 20 years and have NEVER used a 14g needle but I have hand withdrawn through a Central Line which is a very time consuming task     

Robbin George RN VA-BC

I have also never used a 14

I have also never used a 14 g for this procedure. We routinely used 18 g. 

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway, M.Ed., NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

We do therapeutic
We do therapeutic phlebotomies routinely and never use a 14g.  We use 20g Intima catheters successfully without a problem. We have a standardized protocol that allows hydration if systolic BP is less than 10mm than patient's  average systolic or patient becomes orthostatic after the procedure.  We recommend patient hydrate the night before visit and hold antihypertensives the morning of phlebotomy.  We rarely have adverse events.
Would it be possible to get

Would it be possible to get a copy of your protocol?

My email is [email protected].


Thank you

We have done Therapeutic
We have done Therapeutic Phlebotomy at the hospital I work for several years and use an 18 gauge IV cannula to access the vein.  A 20 gauge has been used if unable to access with an 18 gauge.  Once the vein is cannulated we attach a pressure tubing to the hub of the catheter then having already placed an 18 gauge needle on the other end of the pressure tubing we insert that needle into a vacutainer bottle which works quite successfully for us.  You are welcome to e-mail me at [email protected] for any further questions.
gaelyn lovejoy
Like many of the other

Like many of the other comments we never use a 14ga needle.  We use what ever the patient's vascularture will support.  We also use a vacutainer bottle to collect the blood.  It is less time consuming, decreases the risk of blood exposure and infection. 

Deb Gnegy
What length catheter is

What length catheter is best?  I just started working in our ambulatory infusion clinic and they're using 1 1/4 length catheters.  I suggested shorter ones. 

We're using the catheters that we use for PIV therapy. 

Is there a prefered type/brand of catheter for phlebotomy or is there a manufactured phlebotomy catheter?

Also, I'm looking for info on what to do when the blood won't flow.  This week we had a patient that has 500ml removed every 2 months and after 3 IV starts and several vacuum bottle changes we ended up drawing the blood with syringes.


We use a Baxter 4R3611

We use a Baxter 4R3611 CPDA-1 Whole Blood Bag (usually used for blood donation).  It has less vacuum than the bottles thereby causes little to no venous collapse.  The needle is attached.  We obtain them from the blood bank (or can be ordered independently) and we are very pleased with its use for phlebotomy.  You also need to use a scale if you are using the bag.


Gwen Irwin
One of the problems that we

One of the problems that we encountered was the use of the extension tubing being a microbore tubing.  The IV catheter size could be 20 or 18 ga, but the microbore tubing added additional resistance to allowing the therapeutic phlebotomy.  We do not traditionally use vacuum bottles, but also use the phelbotomy bags.  The bag is placed at a lower height than the patient and has been successful.

I have never used a 14 gauge catheter either.

 Gwen Irwin

Austin, Texas

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