I am seeking informaion from nurses who do therapeutic phlebotomy. I have found a couple of online procedure examples but they are unclear about tourniquet removal. Is the tourniquet left on the arm during the entire withdrawal of the designated amount of blood? I have never practiced that way but am wondering if this is now the practice. Both procedures are confusing in how they are written, so I am seeking info from others. Thanks! Lynn
Lynn, Plumer's 9th ed. describes the procedure and indicates removal of the tourniquet after the prescribed amount of blood has been withdrawn. When I did TPs, we did it both ways: remove the tourniquet once blood flow as established or leave it on throughout the procedure. Usually it was based on patient comfort, though I would usually leave the tourniquet on for the polycythemia vera patients, because their blood seemed so much thicker (I'm sure that was my imagination). It was rare that a patient would complain of the tourniquet once blood flow started, as long as it wasn't too tight to constrict arterial blood flow. It's too bad INS SoP/PaP 2016 couldn't include the procedure. Even though it is described in Plumer's, there does not appear to be a primary source referenced to support it.
Keith W. Gilchrist, MSN, RN, PHN, OCN, CRNI, VA-BC
Oncology Nurse Navigator, David Grant Medical Center
Travis AFB, CA
Lynn. I am attaching a small section of our institution's P&P regarding the tourniquet. If you need more I can email it to you :)
Valorie
tourniquet should never to be on for more than 1 (one) minute), have the patient open and close hand until the previously selected vein is again prominent. Do not palpate the vein.
c.Perform venipuncture.
d.Confirm that collection bag is well below the level of the venipuncture site.
e.Loosen the tourniquet, do not leave tourniquet tightened for venesection, will restrict blood flow.
Valorie Dunn,BSN, RN, CRNI, PLNC
Therapeutic Phlebotomy is the same as donating whole blood. We use a BP cuff as a tourniquet. It makes it easier to control the pressure. Pump it up to 60mmHg to find a vein and/or perform venipuncture, then lower pressure to 30 to 40mmHg for the procedure. The speed at which you collect (or drain) the blood depends on your patient and their status. We allow up to 20 minutes for a 'donation of whole blood' (from Healthy Donors). Most of my donors complete their donation in 5-10 minutes with out problems. Lower the pressure on the cuff if you wish it to flow out slower, just be sure it stays continuous or it may clot.