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We do both active and passive therapeutic phlebotomy treatments in our apheresis clinic. The kids are treated on a stretcher, but our SOP says that patients >80lbs can be treated in a chair. General workflow:
Place at least a 20 gauge IV (preferably large) or access CVC (we use a 17G fistula needle for passive phlebotomy)
apply Synera for 20-30min to intended site
sometimes ultrasound guidance is used for IV placement
use AC unless large vein is accessible elsewhere on the arm.
Send labs with criteria to draw based on Hgb
Active phlebotomy: draw blood manually using 10 or 20mL syringes. Usually draw through a needless connector, but at times we will remove the cap for better flow.
Passive phlebotomy: pt is connected to the genesis mixer.
pts receive either po or IV hydration….most of the younger kids (school age and below, get IV hydration post.
VS pre and post
We ask kids to po hydrate the day before and day of the procedure. Hot packs and ensuring the patient is warm (blankets prn) and relaxed helps with flow and vasospasm. We also find that distraction helps too!
Looking at our procedure for therapeutic phlebotomy. Would anyone care to share their current process? We see pt in our outpatient IV room, usually do the phlebotomy in a chair, with a peripheral IV and active (vs passive or gravity) phlebotomy. We are curious if anyone is using passive measures, and if they are working well-do you have any tips? Do you use a bag, syringe, or vacutainers for the blood? Oral or IV hydration? Do you have a policy or procedure you could share? Happy to post the results of the comments if anyone else is interested. thanks Kathy
—————————— Kathy Ackerman, MSN, PCNS-BC CNS-Pediatrics MSK Kids, Memorial Sloan Kettering Cancer Center NY, NY ——————————