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 RN VA-BC
I have also never used a 14 g for this procedure. We routinely used 18 g.
Lynn Hadaway, M.Ed., RN, BC, CRNI
www.hadawayassociates.com
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
Would it be possible to get a copy of your protocol?
My email is [email protected].
Thank you
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.
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.
Deb
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.
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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