Therapeutic Phlebotomies

[Regina Castor]

I am looking for some best practices as far as Therapeutic Phlebotomies.

Who is performing them in your hospital? If Blood Bank performs them, do you draw donors routinely?

Are physicians required to give advanced notice? Do you do these stat?

[ShowDogDad]

Hey there. Our hospital blood bank draws quite a few TP's. It is pretty rare that we do an inpatient, most of ours are outpatients. As far as timing, our OP's schedule an appt and come in with a prescription from their MD. We have done IP's stat. We just have to make sure that all the paperwork is done.

[anti]

We do not perform many inpatient TPs. Predominantly performed by our Cancer Center phlebotomists. If it is after-hours or inpatient, then we have to hunt for one of the old-timers that used to collect autologous donors, or one of our seasoned phlebotomists that have internally received approval. Most of our inpatient TPs are for sickle cell.

[shelleyk482]

The Dialysis nurses do the TP's at our facility. We do just inpatients and they have to be worked in since dialysis patients have priority; all outpatients are referred to the blood center.

[huntilla]

Most of our therapeutic phleb procedures are performed on Outpatient referrals from our oncology physicians, I have done two or three inpatients in a five year tenure at my current job. Our facility does not draw donors and most of our "regulars" are coming to us for the proximity factor. The regional blood center will perform these but it is another 10 minutes down the road and I believe they are still required to ask most of the dear donor questions? (correct me If I am wrong) I only have tenured techs performing these at this time and I try to schedule most of them on dayshift hours so myself or the other senior blood bank tech can perform the procedure.

Lotsa Luck

Barr Antilla

[Ann Viernes]

I'm attaching our SOP for Therapeutic Phlebotomies. Most are OP, some IP. The IP are either done in the patient's room or transport brings them down to our donor center. Therapeutic Phlebotomies are not a regulated procedure, since they are not a donation (unless you cross them over--we don't). There's probably a question or two on the CAP and AABB checklist but these mostly refer to crossed over therapeutic units for transfusion. the only item not included in the attachment is our hospital's informed consent. That is a hospital document. Your hospital surely has these for minor procedures.

We do have an inhouse whole blood donor collection and apheresis collection and therapeutic apheresis department as part of our blood center. Any of the phlebotomists and apheresis specialists can perform the procedure.

A 11 Therapeutic Phlebotomy.pdf

[AMcCord]

We used to do the therapeutic phlebotomies. Appointments were required for outpatients. IP stats were rare and done in the patient's room. We tried to talk them into waiting until day shift when possible though I did have to come in a couple of times on evenings to do one. We usually had someone trained to do them on both weekend crews, so we could handle those requests, too.

About 18 months ago the nurse manager of our Outpatient Infusion

Center asked about taking over TPs. She had been to a conference and discovered that it was something that was done in units like hers. I was delighted to hand that function over to OIC! I think about 30% of her staff is still unhappy with her for doing it . I trained a core group of 4 RNs on the OIC unit, gave them detailed info on the care and feeding of our regular customers and held their hands for a couple of months, if asked. They are doing fine. Their schedule allows more flexibility for OP appointments. IP requests are arranged with them on a case by case basis.

I am thrilled to get rid of the whole process, though I do miss seeing some of the regulars - you do get pretty acquainted with some of them.

[GilTphoto]

Therapeutic phlebotomies are medical procedures that should not be done by phlebotomists or med techs. This is not like drawing a unit for donation on a healthy person. These patients are sick and have other complications and expose the hospital to a huge risk if not done by someone qualified. In our hospital, the house physician used to do it, but they are not trained and do not have the right equipment. If you do not have a scale to know when you have drawn off the requested number of mLs, you may get too little or too much. We have a contract with a mobile apheresis service that does it. It removes the liability from us, from any complications that may arise.

Gil

[n.peters]

In your facilities, if an out patient nurse performs a therapeutic phlebotomy does the blood come back to you lab to be destroyed? Is it ordered in LIS as a lab test? Does anyone have any suggestions about that? We recently gave TP's up to our out patient cancer center and the TP's still come down to the blood bank/lab to be destroyed and resutled in LIS. Ther seems to be alot of concern about who does what and what charges are placed.

[shelleyk482]

The only involvement we have with the TP's is that the Transfusion Committee reviews the SOP on a biannual basis; nursing reviews it annually. We do not received the product, it is not entered into the LIS; we basically handed the entire process to the nursing department since we view it as a medical procedure and not a blood product.

[John C. Staley]

We have absolutely nothing to do with therapeutic phlebotomies. They are performed in IV Therapy by the nurses. We are completely out of the loop and see no reason to get involved.

[Mabel Adams]

We have never done TPs. If they aren't done at the blood center, nursing does them. The closest we get to them is answering the phone call, "Do we get the blood bags from you?" with "call central supply."

[AMcCord]

I see it the way Gil does, though our previous Medical Director did not. That is why I was so delighted to hand it off to nursing and why the lab manager was quick to agree with me. RNs are better equipped to handle any complications, administer meds if necessary, etc. etc. All orders, documentation, any reports - all done by the OIC. They do bring the bags down to us for disposal in our waste but red bagging is really all that needs to be done. We handed over our equipment and Materials Management stocks their supplies. It has worked well.

[ShowDogDad]

We have RN's and techs here in our Donor Center. The RN is responsible for screening the TP patient. Either a tech or a nurse may do the actual phlebotomy, but if replacement fluids are required, the RN must do that. After the phlebotomy, our bags of blood are double bagged and placed in infectious waste.