amym1586 Posted October 28, 2015 Share Posted October 28, 2015 I'm having the worst time with therapeutic phlebotomies. Can someone give me some tips and pointers. I'm a novice to put it nicely at normal phlebotomies. I often experience a tugging or pulling feeling on the big needle. What is happening in that situation ? I have another patient who has a huge juicy vein but there is so much swelling around the needle site that I can't finish the procedure. I have another who has no veins and I have to have a phleb help me syringe him. We are working on ordering 20 gauge needles to help with the syringe process. Do they make donor bags with smaller needles. We obviously aren't concerned with hemolysis. Thanks for any help ! Link to comment Share on other sites More sharing options...
goodchild Posted October 28, 2015 Share Posted October 28, 2015 Practice, confidence, and make sure you're going in at a low angle. I haven't done any collections since 2009 but prior to that it was countless hundreds (maybe thousands?) of donor units. That's the best I can pull from memory. AMcCord and amym1586 2 Link to comment Share on other sites More sharing options...
David Saikin Posted October 29, 2015 Share Posted October 29, 2015 You can buy Macopharma bags - and put your own needle on the bag. I have a few pts that cannot tolerate the 16g so I draw them using a 19g. sounds like you may not be putting the "spike" all the way into that large vein. As Goodchild says - practice and confidence. AMcCord, amym1586 and Malcolm Needs 3 Link to comment Share on other sites More sharing options...
jayinsat Posted October 29, 2015 Share Posted October 29, 2015 I hate those things! If I could get rid of them I would. So few facilities are doing them still. Even our regional donor center stopped doing them. Most in this area are done in the physicians office. That said, from my experience, the higher the pre-hct, the slower and more viscous the blood flow, which makes a normal gravity collection very difficult. Combined with poor veins, you have a difficult situation, even for the best, most experienced phlebotomists. I've seen large men with huge pipeline veins that were easy to stick but were impossible to collect a full unit with a normal bag. I truly believe it was the 60 hct that caused the issue. amym1586 1 Link to comment Share on other sites More sharing options...
amym1586 Posted October 29, 2015 Author Share Posted October 29, 2015 We found some 20g butterflies to order and I have to find those Macopharma bags! That would seriously change my life hahaIf the 20 are still too small. I'll see if my supervisor can find some 19g to order for us. Thank you so much! Link to comment Share on other sites More sharing options...
David Saikin Posted October 29, 2015 Share Posted October 29, 2015 go with 19 butterflies if you can BUT BE WARNED - the tubing from the butterfly to the bag is about half the size (diameter) of the bag tubing. It takes a bit longer to draw using a butterfly. I use 19g syringe needles and attach them to the MacoPharma bag - there is not that lag created by the smaller diameter butterfly tubing. Remember, the smaller the needle bore the longer the procedure will take. Malcolm Needs 1 Link to comment Share on other sites More sharing options...
amym1586 Posted October 29, 2015 Author Share Posted October 29, 2015 Just found the bags! Ordering them 1st of the month! In my head I was thinking I would need the butterfly tubing to attach the bag. But if a straight syringe needle will work even better. That's what we'll order! Thank you again you just made my day and several of my patients will be very happy. Malcolm Needs and Maureen 2 Link to comment Share on other sites More sharing options...
AMcCord Posted October 29, 2015 Share Posted October 29, 2015 You can buy Macopharma bags - and put your own needle on the bag. I have a few pts that cannot tolerate the 16g so I draw them using a 19g.sounds like you may not be putting the "spike" all the way into that large vein.As Goodchild says - practice and confidence. David, where were you when I needed this information ? Those would have been great! I was really glad to send this procedure to the infusion clinic. However, I agree with previous comments...with practice you get better. And those high Hcts flow like thick syrup. Some of them will clot off before you get a full bag. On the bright side, once you get good with therapeutics/donor bags, you'll regard routine blood draws as a piece of cake. Even the hard draws. "Butterfly? I don't need no stinkin' butterfly!" amym1586, Malcolm Needs, David Saikin and 2 others 5 Link to comment Share on other sites More sharing options...
tricore Posted October 30, 2015 Share Posted October 30, 2015 Try a dialysis needle.We used to have a thin wall 17g needle with a back eye that we would attach to the bag. Probably Terumo. They were sharper than other needles.When we had a patient with sludge for blood our medical director used to give them a dose of heparin so the blood would not clot in the tubing. The ones with the real high crits are the ones who really need the phlebotomy. amym1586 1 Link to comment Share on other sites More sharing options...
amym1586 Posted October 30, 2015 Author Share Posted October 30, 2015 Most all of my patients have hemochromatosis. Their crits are usually normal or slightly low. But several have hepatitis/ history of IV drug use and just crappy veins. I've had one that got sent over from another hospital with a crit of 57 and that blood was so dark it looked black. She was on constant oxygen. She got some relief after that draw. Link to comment Share on other sites More sharing options...
tricore Posted October 30, 2015 Share Posted October 30, 2015 I performed a double unit TP on a patient with a high crit whose nose was bluish purple. After the first unit was removed we gave him a liter of saline and his nose went back to nornal color. It was quite a dramatic change. amym1586 1 Link to comment Share on other sites More sharing options...
amym1586 Posted February 10, 2016 Author Share Posted February 10, 2016 What do you think... I've got a polycythemia TP patient that comes in crit over 50. He comes so slow with the 18 and 19 Gauge needles hooked to the bag he clots off before half way through the procedure. He won't let you stick him more than once. Would I have any better luck getting him with a smaller needle and pulling some big syringes. He has monster good veins. But he jumps out of the chair with those big needles. Link to comment Share on other sites More sharing options...
SMILLER Posted February 10, 2016 Share Posted February 10, 2016 We've had to do that for patients with poor veins, it's pretty tedious but it works. Might even be easier with big veins though. Scott amym1586 1 Link to comment Share on other sites More sharing options...
amym1586 Posted February 10, 2016 Author Share Posted February 10, 2016 2 hours ago, SMILLER said: We've had to do that for patients with poor veins, it's pretty tedious but it works. Might even be easier with big veins though. Scott yeah, I've got another patient we syringe with but he's got a normal crit. I'll try the high crit guy with the syringes next time he comes in. Luckily I've been working out. Malcolm Needs and SMILLER 2 Link to comment Share on other sites More sharing options...
tbostock Posted February 10, 2016 Share Posted February 10, 2016 We just started using TheraSafe therapeutic phlebotomy sets. It's a 17 gauge needle, a smaller gauge and also a shorter needle. There's also an air vent on it that removes air from the bag and increases the flow. Each bag is individually wrapped which is nice. And they have graduated markings on them so you don't need to use a scale. They are distributed by Genesis. http://www.genesisbps.com/therasafe.html AMcCord, David Saikin and amym1586 3 Link to comment Share on other sites More sharing options...
AMcCord Posted February 11, 2016 Share Posted February 11, 2016 17 hours ago, tbostock said: We just started using TheraSafe therapeutic phlebotomy sets. It's a 17 gauge needle, a smaller gauge and also a shorter needle. There's also an air vent on it that removes air from the bag and increases the flow. Each bag is individually wrapped which is nice. And they have graduated markings on them so you don't need to use a scale. They are distributed by Genesis. http://www.genesisbps.com/therasafe.html What an awesome product! Wish I had know about them when I was doing the therapeutics. amym1586 1 Link to comment Share on other sites More sharing options...
David Saikin Posted February 11, 2016 Share Posted February 11, 2016 18 hours ago, amym1586 said: yeah, I've got another patient we syringe with but he's got a normal crit. I'll try the high crit guy with the syringes next time he comes in. Luckily I've been working out. You can also try using vacutainers and drawing a ton of tubes. I've gone that route with a few pts. amym1586 1 Link to comment Share on other sites More sharing options...
BankerGirl Posted February 11, 2016 Share Posted February 11, 2016 19 hours ago, tbostock said: We just started using TheraSafe therapeutic phlebotomy sets. It's a 17 gauge needle, a smaller gauge and also a shorter needle. There's also an air vent on it that removes air from the bag and increases the flow. Each bag is individually wrapped which is nice. And they have graduated markings on them so you don't need to use a scale. They are distributed by Genesis. http://www.genesisbps.com/therasafe.html I requested a quote for this fabulous-sounding product just now. This would be great for us! amym1586 1 Link to comment Share on other sites More sharing options...
David Saikin Posted February 11, 2016 Share Posted February 11, 2016 3 hours ago, BankerGirl said: 3 hours ago, BankerGirl said: I requested a quote for this fabulous-sounding product just now. This would be great for us! I think you still need to weigh the bag when you are done. Granted there are delineations on it, and also on the MacoPharma bag, but you will need to determine when the actual bag volume equals the volume delineated by the markings. I also think the MP bags are a big less expensive and you can use an even smaller g needle if you need to. amym1586 1 Link to comment Share on other sites More sharing options...
amym1586 Posted March 28, 2016 Author Share Posted March 28, 2016 (edited) So I've been trying out the MacoPharma bags. And every time the bag stops flowing at about 296 grams. Different patients/ different phlebotomist. Any tips ? @David Saikin Edited March 30, 2016 by amym1586 Link to comment Share on other sites More sharing options...
Dr. Pepper Posted March 28, 2016 Share Posted March 28, 2016 On 10/28/2015 at 0:56 PM, amym1586 said: I have another patient who has a huge juicy vein but there is so much swelling around the needle site that I can't finish the procedure. You have probably transfixed the vein, half in and half out, so the bag is filling but they're also bleeding into the surrounding tissue, as David suggested. Goodchild's advice about the shallow angle is right on. Your insertion should be like tracing a J that's lying on its back. Down and in to puncture the vein, then slide the needle a bit into the vein parallel to the arm. It's a big lumen to the needle and needs to be all the way in the vein. Malcolm Needs and amym1586 2 Link to comment Share on other sites More sharing options...
David Saikin Posted March 31, 2016 Share Posted March 31, 2016 On Monday, March 28, 2016 at 10:22 AM, amym1586 said: So I've been trying out the MacoPharma bags. And every time the bag stops flowing at about 296 grams. Different patients/ different phlebotomist. Any tips ? @David Saikin I don't know what to tell you about this. Interesting phenomenon but I have yet to see it. Are you using a big enough needle? I use 19g and can usually fill the bag right up . . . Link to comment Share on other sites More sharing options...
Kip Kuttner Posted March 31, 2016 Share Posted March 31, 2016 Hello, Here are a few suggestions that have served me, and our phlebotomy staff well over the years. We do therapeutic phlebotomy at the blood center (all sorts of diagnoses). When you prepare for the phlebotomy identify the select the best vein (obviously). The median cubital vein is usually most preferable because, in general, you will have less risk of inadvertently injuring a nerve. The basilic vein is a danger zone because of the nerves in the area and proximity to the brachial artery. Once you have a good understanding of how the vein travels, visualize the layers of tissue the needle will go through before striking the vein. Skin, subcutaneous fat, fascia, vein. The amount of each layer will vary with the physique of the patient/donor. Try to mentally picture the lumen of the vein being entered by the needle. Insert the needle at between 15 and 30 degrees from the skin. Normally and with experience you will feel increased resistance as the needle enters the vein and something described as a "pop" as the needle glides into the lumen of the vein. The 15-30 degrees is important because it gives you some leeway with the needle. It stays longer in the lumen as the needle advances, before going through the opposite wall of the vein. As the medical director of a medium size blood center I have seen my share of hematomas and they are usually caused by traversing the vein. In addition, with those big juicey veins, a frequent mistake is applying the tourniquet too tightly. this causes blood to leak from the insertion site at the side of the needle because the pressure in the vein exceeds the flow rate of the needle. Another bothersome event is the valves inside the veins, especially on larger veins, can cover the bevel of the needle. You will swear you are inside the vein, get a flash of blood and then nothing. Occasionally the leaflet can be dislodged by rotating the needle to the right or left. NEVER redirect the big needles. I demonstrate how much damage can be done by filleting a pork chop with a whole blood phlebotomy needle. My personal best time is 15 seconds to separate the meat from the bone. All the best AMcCord and amym1586 2 Link to comment Share on other sites More sharing options...
amym1586 Posted April 1, 2016 Author Share Posted April 1, 2016 On 3/31/2016 at 6:04 AM, David Saikin said: I don't know what to tell you about this. Interesting phenomenon but I have yet to see it. Are you using a big enough needle? I use 19g and can usually fill the bag right up . . . Yeah, We've tried 19G and 18G. I don't know what the deal is. Link to comment Share on other sites More sharing options...
David Saikin Posted April 4, 2016 Share Posted April 4, 2016 what do you have your bag suspended on? A counter weight beam balance? an electronic weigher/mixer? How do you know how much you are drawing? ANORRIS 1 Link to comment Share on other sites More sharing options...
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