Policy Area: Nursing Procedure - Phlebotomy - Therapeutic POLICY: DEFINITION/PURPOSE: SUPPLIES: Therapeutic phlebotomy may only be performed by nursing staff that have completed the competency for this skill, or by physician familiar with the procedure. The procedure is ordered as a treatment for hereditary hemochromatosis, polycythemia vera, and secondary polycythemia. It is a technique done by nursing staff with the continuous supervision of a doctor during the procedure. The patient's blood pressure, pulse and hemoglobin/hematocrit are checked prior to each phlebotomy. One common procedure nurses perform is therapeutic phlebotomy, where about 500 ml of blood is removed through a large-bore needle over 15-30 minutes. Whether you need to fast before your therapeutic phlebotomy; Whether you should have someone drive you home after the procedure; You may need to stop taking some medications up to 1 week before the procedure. ... You may be able to undergo therapeutic phlebotomy at your local blood donation center. WHO intends these guidelines to help improve outcomes for health care providers and their patients, to share information about the risks associated with drawing blood, to increase safe practices, and to reduce blood-borne virus exposure and transmission. The usual indication for phlebotomy is an abnormally high hematocrit (primary or secondary polycythemia). doi: 10.2450/2013.0299-12. Therapeutic phlebotomy is a procedure to remove blood from the body. It helps decrease high levels of iron or red blood cells. PURPOSE . Consent: Ensure consent for therapeutic phlebotomy has been obtained prior to initiation Vitals Baseline T, HR, RR, BP, SpO 2 prior to initiation of procedure T, HR, RR, BP, SpO 2 immediately post procedure then, q15 minutes x2 Monitoring Monitor for adverse reactions such as nausea, shortness of breath, chest pain and orthostatic hypotension  |  It is commonly performed in a blood donor center, apheresis unit, physician office, or at home by a well-trained phlebotomist, but home phlebotomy is rarely performed.8 The prescription for phlebotomy should contain the fol-lowing elements: 1.Patient’s name Current applications of therapeutic phlebotomy. f%��������h�Rnn�L}�JQ�|]p�)"��DE�]��K:�FKB�+R K�F�٦c�. (In front of patient) ***This is an OSHA regulation*** 2. Page 1 of 1 Please see links below for Therapeutic Phlebotomy procedure, which is now located in Lippincott. I… HHS 2014 Jun;29(3):133-8. doi: 10.1002/jca.21303. Title: 8850162_1.xls Author: Tim Rolf Created Date: (INS P&P for Infusion Nursing. The three most common reasons for therapeutic phlebotomy are: In some ways, therapeutic phlebotomy is similar to a routine phlebotomy procedure in that it also involves the withdrawal of blood and the use of similar equipment such as needles and sterilization … The ordering physician is responsible for the care provided during procedure. QUALITY CONTROL: Confirm the patient’s identity against the physician’s orders for the therapeutic phlebotomy. �H�H�TƛS������Źl�^7%����@L�r6���h4�4IZD���q��"��H4��G��!�rsPg I H��>x�lI*� �!g ��~��mp摨�A�|�2ai�|���\��Y��j���Ś0�Y��s?�{���/��#�yf��P��xۋTÊ�^���m7$�8�Z �b�.��l��V�U�Qb-j@‘������wT9[�\.�iK|*r�YJ�h;K���o�a<5�1T�.K�☁��Q�6q_��n�8nZ�_�#e�tA��8804��k'گ2) ����ʥ#�>��\s`�[J,��Q�!�:rܵ�6D��6p��E('\) b5@u3����!p�~�^����#$�l;��?,=* �19��b���%��^���>��s��l3O�ɹ��'�� }N��q-"ځ���uBTka�ȢM�21�[�oE?�>p1�r�����.K������:W���k!�iyL��u���䆵�tǦ��u4Ǜ'��eP�"���-很���B��ES�{z�z��sa�Zf����Th�էC�d4M���\�ki�8�mA`���9*��y��Қ8�?���u�n��V��:���� One common procedure nurses perform is therapeutic phlebotomy, where about 500 ml of blood is removed through a large-bore needle over 15-30 minutes. endobj Evers D, Kerkhoffs JL, Van Egmond L, Wijermans PW. Therapeutic phlebotomy is a procedure to remove blood from your body. A report will be sent to the ordering physician or other authorized health professional. USA.gov. One or two peripheral intravenous lines (PIVs) are started to perform the procedure if you do not have any other type of vascular access device (CVL or portacath). �˂n&�B-#Z��;�X)�' As a result, oncology nurses often are required to care for these patients. 4 0 obj To get ready for your procedure: Drink plenty of fluids; Wear clothing with sleeves that can easily be rolled up above the elbow Epub 2013 Oct 3. Its used to make hemoglobin, which oxygenates your cells. If systolic or diastolic has dropped by 20 mm/Hg or more from the prephlebotomy blood pressure, the patient must be admitted to the ER and seen by the ER physician before he can be released. Therapeutic phlebotomy: The removal of a specific amount (volume) of blood from a patient for treatment of a specific condition or disease. One common procedure nurses perform is therapeutic phlebotomy, where about 500 ml of blood is removed through a large-bore needle over 15-30 minutes. NURSING ALERT: Standardizing Best Nursing Practice for Implanted Ports: Applying Evidence-based Professional Guidelines to Prevent Central Line-Associated Bloodstream Infections The New Gold Standard in Infusion Nursing Although many individuals are familiar with term phlebotomy, as it is a common and routine procedure for diagnostic testing, many individuals are unfamiliar with the term therapeutic phlebotomy.. Current view of an ancient treatment]. NURSING PROCEDURE TITLE: THERAPEUTIC PHLEBOTOMY (Adult) A. Therapeutic Phlebotomy is the same as donating whole blood. This is a condition called hemochromatosis. 2010 Mar-Apr;33(2):81-8. doi: 10.1097/NAN.0b013e3181d00010.  |  It’s intended to decrease one’s blood level as well as reduce red cell mass and iron storage. The patient's health status must be medically stable enough to tolerate the therapeutic phlebotomy process. There are specific steps in performing a phlebotomy procedure in order to achieve the best results. PROCEDURE B. POST-PROCEDURE CATEGORY: SPECIAL NURSING PROCEDURE – RN PURPOSE To remove a specific volume of blood from a patient for a specific condition or disease. Nowadays, therapeutic phlebotomy (TP) is the first option in polycythemia vera (PV) treatment. To reduce blood viscosity for a specific condition or disease. In hemochromatosis, therapeutic phlebotomy is a procedure that removes blood from a person’s body with the specific goal of reducing iron overload.Therapeutic phlebotomy involves the same procedure as blood donation; the primary difference is the frequency of how often we give blood. 2016). Epub 2013 Oct 15. The patient MUST call to make an appointment. Step 1 – Patient Awareness It is a procedure that many patients fear and can become an unpleasant experience based on the techniques used by the phlebotomist. Phlebotomy Procedure Therapeutic phlebotomy is performed in a medically supervised environment. Document the completed consent form, the name and location of the vein used, your patient's vital signs before and after the phlebotomy, the amount of blood withdrawn, the duration of the procedure, his tolerance of it, any adverse reactions, and your patient teaching. 16-18G needles/angios. Phlebotomy is a fairly simple procedure. [Therapeutic bleeding. 2 0 obj 1. Your body needs a certain amount of iron. intended for transfusion and is discarded after the procedure is completed. 3 0 obj Before initiating the procedure, nurses must be aware of a patient's diagnosis, baseline hemoglobin, hematocrit, ferritin, and therapeutic end points. The procedure is ordered as a treatment for hereditary hemochromatosis, polycythemia vera, and secondary polycythemia. Pump it up to 60mmHg to find a vein and/or perform venipuncture, then lower pressure to 30 to 40mmHg for the procedure. The processes of phlebotomy are pivotal for patient care. Therapeutic phlebotomy: a review of diagnoses and treatment considerations. Get the latest public health information from CDC: https://www.coronavirus.gov, Get the latest research information from NIH: https://www.nih.gov/coronavirus, Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. %PDF-1.5 Would you like email updates of new search results? Once drawn, the blood is not. endobj Transfus Apher Sci. It makes it easier to control the pressure. <> Reviewing these diagnoses will help nurses understand why phlebotomy is an important part of treatment. Blood Transfus. Therapeutic phlebotomy is used to remove excess iron and maintain low normal body iron stores in patients with hemochromatosis. 1. One common procedure nurses perform is therapeutic phlebotomy, where about 500 ml of blood is removed through a large-bore needle over 15 30 minutes. Required textbook: Phlebotomy: A Competency Based Approach (With Connect access code card) (Ed. Phlebotomy (aka venesection) may be recommended quite frequently for a person who has just been diagnosed with iron overload, especially if thei… Nurses may have to perform phlebotomy for their patient in various health care settings. The efficiency of therapeutic erythrocytapheresis compared to phlebotomy: a mathematical tool for predicting response in hereditary hemochromatosis, polycythemia vera, and secondary erythrocytosis. Deflate the blood pressure cuff and remove the needle. But, like anything else, there can be too much of a good thing when it comes to iron in the blood. According to the Oklahoma Blood Institute, therapeutic phlebotomy is the removal of a patient’s blood (usually from the arm) for medical purposes. This procedure is done to treat certain blood disorders, such as hemochromatosis or polycythemia vera. stream Epub 2013 Mar 13. After the strategy of using therapeutic toy dolls and puppets, 40% of the children calmly accepted the venipuncture procedure, and 100% showed a change to their initial negative reaction, became more communicative and cooperative, and participated and interacted with researchers, even after the end of the activity and procedure. V��zՓvqE��f����}^���;�} �z�rL��@-�Z� ��$=1 ,�>���@��������K�U NLM <>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Please enable it to take advantage of the complete set of features! 1.1 To safely remove a specific amount of blood from a patient with a clinical indication as ordered. We use a BP cuff as a tourniquet. During your therapeutic phlebotomy procedure, a nurse will use a needle connected to a blood collection bag to draw a certain amount of your blood. It will not be a determining factor for the program. The center will need a physician's order to complete the therapy.  |  If possible, patient should be given oral fluids during or immediately after procedure. Another indication for phlebotomy is iron overload from hemochromatosis, chronic iron overdose or long term transfusion of chronic anemias. The procedure is ordered as a treatment for hereditary hemochromatosis, polycythemia vera, and secondary polycythemia. hemoglobin/hematocrit level at which the phlebotomy should be performed). 2013 Apr;48(2):187. doi: 10.1016/j.transci.2013.02.030. 1 0 obj A nurse checks your child’s blood pressure, heart rate, breathing, temperature, and oxygen level before, during, and after the procedure. <> COVID-19 is an emerging, rapidly evolving situation. MATERIALS/SUPPLIES: A. As a result, oncology nurses often are required to care for these patients. After the right amount of blood is drawn, the nurse will remove the needle and place a pressure bandage (bandage that wraps around your arm) over the needle site (the place on your arm where the needle was). Many oncology practices treat patients with benign and malignant hematologic diagnoses. <>>> 2014 Jan;12 Suppl 1(Suppl 1):s75-83. It can be done in a physician's office, hospital, or at a blood donation center. Clipboard, Search History, and several other advanced features are temporarily unavailable. The efficiency of therapeutic erythrocytapheresis compared to phlebotomy in relation to blood volume and delta-hematocrit: an evaluation in hereditary hemochromatosis polycythemia vera and secondary erythrocytosis. Therapeutic Phlebotomy Department Time Square, 660 SW 39th Street, Suite 245, Renton, WA 98057 (800) 266-4033 or (425) 453-5098 Fax (425) 251-1977 Email: therapeuticphlebotomy@bloodworksnw.org Informed Consent for Therapeutic Phlebotomy for Polycythemia Vera Procedure: Therapeutic Phlebotomy consists of inserting a needle through the skin into a vein, and One common procedure nurses perform is therapeutic phlebotomy, where about 500 ml of blood is removed through a large-bore needle over 15-30 minutes. The procedure is ordered as a treatment for hereditary hemochromatosis, polycythemia vera, and secondary polycythemia. When the desired volume of blood has been removed, place a hemostat on the transfer pack tubing and close the white pinch clamp on the needle line. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. Therapeutic phlebotomy can be a life-saving treatment for patients with too much iron in their blood. endobj Evers D, Kerkhoffs JL, Van Egmond L, Schipperus MR, Wijermans PW. This site needs JavaScript to work properly. Take the patient’s blood pressure after the phlebotomy in the opposite arm and record this on the Therapeutic Phlebotomy Form in the appropriate place. NIH %���� x��io�6����f�F�Mi�;�n��X��0�'M|ԙl�_�|�)��Ɩw�EaF"�����&On�o^mN��'�ޜo.�\m�o��?n�5���q�"��[��������%]s{����G����g�03�ec_��|���E�y�j7H���@ A-����{����g�{'�'k�V7kܛ�횠�5|�����9|:��?ֿ4/���{�P|wOjz�2��5�P�$�͋ӓU�,����*r�r-W��+�h��u������B����\�8̘�W#nI1��ke �1X����İr��א�%�l�!ONx˻&��^��"e-�2�����ybT�g_5��1x����xڠ��6W������������0� Phlebotomist Procedure Checklist. The World Health Organization has issued practice guidelines for nurses who draw blood, which is referred to as phlebotomy. Understanding the procedures, processes and reasons behind phlebotomy is the key to ensuring patient safety and positive patient outcomes. 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