The University of Iowa Hospitals and Clinics
Department of Pathology
DeGowin Blood Center
GUIDELINES FOR THERAPEUTIC PHLEBOTOMY
PERFORMED BY THE CLINICAL SERVICE

Policy:
Therapeutic phlebotomies are performed on outpatients and inpatients on a Monday-Friday, 0800-1700 basis either in the DeGowin Blood Center Patient Services area or on the inpatient unit. Because DeGowin Blood Center staff do not perform therapeutic phlebotomies after business hours, requests for procedures after hours or on weekends and holidays must be directed to the pathology resident who will advise clinical physicians that: (1) this service is not available; (2) phlebotomy can be done at the bedside using a large butterfly needle with multiple syringes to be filled sequentially; (3) a transfer pack and a needle for performing the procedure are available for the floor team to pick up in the blood bank, if they wish to use one collection bag rather than multiple syringes (no scale will be provided); and (4) blood collected must be disposed of properly in biohazard waste and will not be kept for reinfusion.

To perform a therapeutic phlebotomy with supplies from the Blood Bank:
Position the blood pressure cuff on the patient’s arm in a fashion to avoid dragging the tubing over the venipuncture site. Inflate the cuff and palpate the vein. Deflate the cuff. Place a towel under the patient’s arm and over the blood pressure cuff covering the cuff, the patient’s upper arm and shoulder. Prepare the venipuncture site with betadine scrub or alcohol swab.

Connect needle to transfer pack. Place a hemostat on the needle line. Inflate the blood pressure cuff, perform the venipuncture and secure the needle with tape.

Remove hemostat from needle line and allow blood to flow into the transfer pack. A scale may be used to weigh the blood as it is withdrawn. One gram equals approximately 1 mL. A typical "one unit" phlebotomy of blood is approximately 500 grams. A transfer pack holds approximately 600 mL when full.

The blood should be collected at a rate that the patient can tolerate, generally over 10-15 minutes. Observe the patient for adverse reactions during and immediately following the procedure. If possible, patient should be given oral fluids during or immediately after procedure.

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. Deflate the blood pressure cuff and remove the needle.

Apply pressure to the venipuncture site using a gauze 4x4 until the bleeding has stopped. Remove the needle from the transfer pack and place the needle in a sharps biohazard container. Discard the bag in the biohazard trash container.

Alternatively, the patient can be phlebotomized using syringes. 8-9 60 cc syringes are roughly equivalent to one 500 mL unit of blood.

Consult the Pathology resident on call (pager 3404) as needed.