Our med. director would like an inhouse procedure for therapeutic phlebotomy. Most likely this would occur less than once per year or even less often. So, due to rarity of need and competency limitaions, we would like to perform doing a tube draw only. Anyone have a procedure for tube draw therapeutics they like for this purpose and would like to share?

thanks

I have used tubes rarely . . . a better scenario would be to draw with a large bore winged infusion set and some large syringes. I don't have a procedure - I just do it for pts with reduced venous access.

We do about 80-100 a year and have not done this ever. If you are drawing 10ml tubes that would be about 40-45 tubes. On the one patient that needed a tube draw, we had one of the residents do it (in the clinic not the donor area) because we did not have a written procedure.

I think David is right about the large syringes. I've seen one therapeutic phleb that used vacutainer tubes. I can tell you it is SLOW going with lots of tubes being required.

When we did them, we also used large (60 cc) syringes and a large infusion bore infusion set with a double port stopcock. Now oncology does them, and I believe they use the syringe technique and bags when possible.

I would recommend not utilizing a tube procedure, in our experience we have had difficulty supporting the infusion set for more than twenty tubes. In the past when we have collected tubes it typically requires two to four venipunctures to complete the order. The needle typically gets obstructed by clot and it is not possible to strip tubing on the winged infusion set. I would support using the syringe method as this will not collapse smaller veins to the same extent as tube draws.

Good luck,

Barr

thanks for the info. I'll have to look into the options with a large bore infusion set and syringes. Makes sense to me to have that on hand than trying to have all the items we would need for a unit collection.

I have also done a few phlebotomies with vacutainers - difficult venous access on a particular patient. We stocked a box of 20 mL vacutainer tubes just for this patient. It is not a method I would recommend. The point made about having to perform multiple venipunctures due to clots/obstruction of the needle is dead on target.