dsq222 VCF53VV U330-29/GAP-66 Standard Therapeutic Phlebotomy Care ADM POLICY NO.: 330-29 DEPT POLICY NO.: GAP-66 DATE: REVIEW DATE: 11/2/2016 REVISION DATE: 11/21/2022 D5ER4T3GN CPRINCIPLE 1. Therapeutic phlebotomy is a term used when a phlebotomy is done for medical indications. No phlebotomies are done at Taylor Regional Hospital for the purpose of blood donation intended for transfusions. 2. Therapeutic phlebotomies may be ordered for patients who are E345 hemochromatosis. Polycythemia is an increased concentration of erythrocytes in the blood above the normal for age and sex. Absolute polycythemia refers to an increase in the total red cell mass in the body; in relative polycythemia, the total red cell mass is normal, but the hematocrit is elevated because the plasma volume is decreased. 3. Phlebotomies may be used as therapy for absolute polycythemia which may be classified as follows: 1. Autonomous cell production: polycythemia vera and myeloproliferative disorders. 2. Hypoxia 1. Arterial oxygen desaturation: high altitude, pulmonary disease, cyanotic heart disease, methemoglobinemia 2. High affinity hemoglobinopathy. 3. Ectopic erythrocyte stimulating factor production: 1. Neoplasm (rarely, renal cell cancer, uterine leiomyoma). 2. Hereditary: recessive familial erythrocytosis. 4. Benign familial polycythemia. PROCEDURE 1. Confirm and document on nursing assessment Therapeutic Phlebotomy Procedure form that you have a doctor’s order that specifies the date, the amount of blood for phlebotomy, and the pre-procedure hemoglobin, hematocrit and/or ferritin justifying the procedure. 2. Obtain a consent form for therapeutic phlebotomy signed by the patient. Laboratory personnel will verify the consent is signed prior to the procedure. 3. Obtain baseline hemoglobin and hematocrit before beginning procedure and any other labs ordered by the physician that may include ferritin. Communicate results to provider ordering therapeutic phlebotomy if outside expected range. 4. Obtain baseline vital signs, weight and assessment of wellness prior to procedure on Therapeutic Phlebotomy Procedure Form. including hydration status. 5. Gather supplies (completed by lab personnel): 1. Personal protective equipment (PPE) 2. Antiseptic swabs 3. 4. 5. 6. Phlebotomy set, which includes tubing set with a blood bag attached. Blood pressure cuff (functions as tourniquet) if using a peripheral site. Hemostat if using peripheral site. 3-way stopcock and 60 cc syringes if using central line (number of syringes needed depends on ordered amount of blood to be withdrawn – procedure to be completed by nursing staff at this point). 6. Wear gloves and other personal protective equipment as appropriate. Utilize Standard Precautions throughout the procedure, 7. The patient should be in a supine or semi-fowlers position. 8. Check the bag and tubing for defects. Locate the peripheral venipuncture site. The antecubital vein may be best. Place a blood pressure cuff on the upper arm and inflate cuff to 60-80 mmHg. Cleanse the site with antiseptic swabs. Insert the pre-attached 16 gauge needle, without touching or re-palpating the vein. Once the site is accessed, secure the needle and tubing with tape and cover site with sterile gauze. Deflate the blood pressure cuff to allow blood to flow freely, yet the cuff should not be deflated entirely. Ensure that the bag is below the level of the donors arm (for peripheral site), and fill the bag to the volume of blood as ordered by physician using a scale. 1. Once blood flow is established, monitor the patients vital signs every 15 minutes or as needed as the patient condition warrants and ensures the adequacy of peripheral circulation. 2. After the ordered amount has been obtained, release blood pressure cuff entirely, tighten loose knot previously formed to tubing, clamp tubing with hemostat. Remove the needle from the patients arm and secure with a sharps safety device, elevate arm, and apply pressure with gauze pad until bleeding has stopped. 3. Obtain vital signs 15 minutes post procedure. Assess for change in blood pressure, dizziness, nausea, mild diaphoresis, pain or discomfort. If systems noted, continue taking vital signs and monitoring for 15 minute intervals until the patient is stable. Take last set of vital signs with orthostatics prior to discharge. Provide pain relief measures as needed and document response. 4. Allow patient to rest for at least 20 minutes following the procedure if needed. 5. Provide the patient with a snack and something to drink while they are resting if needed. 6. Provide patient with education which should include: 1. Leaving the pressure dressing (gauze and tape or gauze and band aid) on for 4-5 hours post procedure. 2. Avoid smoking for one hour. 3. No strenuous activity for 6-8 hours. 4. May resume usual light activities after 1 hour. 5. Maintain adequate food intake; drink 2 liters of fluids for the next 48-72 hours. 6. Avoid alcohol for 72 hours. 7. Documentation should include on the Therapuetic Phlebotomy Procedure Form all the following by lab and nursing staff: 1. Time/Date of procedure 2. Venipuncture site 3. Baseline and post subsequent vital signs, patients weight 4. Patients response to the procedure including any adverse effects 5. Laboratory personnel and nursing staff will document volume of blood extracted 6. Patient teaching, including copies of signed instruction sheets. 7. Pain assessment prior to, during and post procedure as appropriate 8. Pain relief measures provided and patient response if applicable 8. Seal the blood tubing by tying a knot in the tubing, remove the hemostat, and dispose of the filled blood bag according to current regulations for body fluids and other medical waste. The blood filled bag, with tubing and needle secured with sharps device can all be thrown in large sharps container in lab. 9. Scan all three documents into patients chart; Patient signed consent, completed Therapeutic Phlebotomy Procedure Form and original orders to obtain phlebotomy by ordering phsycian. REFERENCES 1. http://medweb.uhcolorado.edu/PnPDocscareAssess_C/cl70801.htm University of Colorado hospital Policy and Procedure Therapeutic Phlebotomy. 2. http://members.tripod.com/hemochromatose/tp.html Therapeutic Phlebotomy for Hereditary Hemochromatosis. 3. http://americanshs.org/diet.htm American HemochromatosisSociety - Diet 4. http://www.americanhs.org/200Dguidelines.htm Americal HemochromatosisSociety - Guidelines. 5. http://www.irondisorders.org/_treatments/ph1/index.hijq Iron Disorders Institute Disorders: Treatment: Phlebotomy 6. Talked with Nancy Holling RN, Team Supervisor of Education Donor Services, American Red Cross River Valley Region Blood Services. 7. Technical Manual 11th Edition — American Association of Blood Banks: Bethesda, Maryland. 1993. 8. Technical Manual 13th Edition - American Association of Blood Banks: Bethesda, Maryland, 1999.
