A-PRF Phlebotomy Guide Dr. Cliff Leachman
Locations to avoid drawing blood:
1. Arms that have massive oedema, traumatic injuries like burns, sclerosis, phlebitis or thrombosis, as the circulation may be compromised or occluded and difficult to penetrate.
2. Ipsilateral arm to mastectomy, neck trauma or indwelling fistula.
3. Areas affected by cellulitis as penetration may seed bacteria into the central circulation.
4. Latex allergy, use latex free bandaids and tourniquet.
5. Tattoos, lead ink may pose a problem
1. Active Blood Cancers eg. leukemia
2. Anabolic steroid users, body builders, blood will not clot.
3. Bleeding disorders, dyscrasias or haematological diseases
- Gauze and tape or round bandaid.
- 70 % Isopropyl alcohol swab.
- Tourniquet, usually rubber tubing and Hollow bore needle; 21 gauge, larger gauges (23-24) used for smaller veins.
- Butterfly Syringe or Vaccutainer system, your preference.
- Latex or Vinyl Gloves
- Blood tubes for collection 10ml. and test tube rack.
- Scissors, giraffe pliers or cotton pliers.
- Small sterile container to separate blood form fibrin clot.
- Blood waste receptacle (test tubes, blood culture vials etc.)
- Before beginning procedure have all equipment assembled and easily accessible. Determine how many 10ml tubes will you need prior to blood draw and remove from packaging. Usually 4-6 tubes depending on the procedure.
- Explain why and what you are going to do to the patient prior to performing the procedure. Computer shots of before and afters and showing the procedure will be helpful
- Place patient in sitting position and make sure arm is resting on a padded surface to increase comfort.
- Preferred site is in the Median Cubital Vein. If veins are inaccessible stop and use some other material. Osteogen plugs or CaSO4 for example.
- Place tourniquet 4-10 cms proximal to intended puncture site and stabilize the patient's arm to minimize movement.
- If vein is inapparent, have the patient tense, and then relax local muscles repeatedly to increase blood flow to the area, apply a warm compress to the area, or tap sharply over the vein to induce reflexive vasodilation.
- Wipe intended puncture site with 70 % Isopropyl alcohol swab in a circular motion from the center outward about 4-5 cm.
- With your non-dominant hand, pull skin taut to stabilize vein.
- Puncture the skin rapidly with the catheter needle bevel up at a 20-30' angle directly over the vein; once in the subcutaneous space, level off the angle of insertion to nearly parallel with skin surface. If you are using a syringe, maintain negative pressure once subcutaneous space is reached, if using Vaccutainer system, push test tube onto needle to create negative pressure.
- Once subcutaneous space is reached, advance the needle into the tissue until blood flow into receptacle begins. At this point draw off as much blood to fill your tubes.
- Get the blood tubes immediately into the centrifuge FAST!
- Remove the tourniquet with your non-dominant hand before removing needle to help prevent hematomas.
- Place gauze over puncture site, then quickly remove the needle. Apply pressure to the puncture site for 3-5 minutes and twice this duration for patients with coagulopathies. Bandaid or tape gauze over injection site.
Processing the Advanced Platelet Rich Fibrin
1. Take the top of the blood tubes and using the giraffe pliers grasp the top of the yellow clot and gently remove the fibrin tube enough so you can trim off the excess red blood cell clot with scissors.
2. While holding the fibrin clot scrape of the excess red blood cells with the periosteal elevator onto the gauze.
3. Place the fibrin tube into the PRF tray and repeat till finished.
4. To make A-PRF+ plugs place the fibrin clot into the barrel and press the piston until the edge of the piston and barrel are equal.
5. Remove with cotton pliers or the giraffe pliers and place in the center of the PRF tray.
6. To make membranes leave the fibrin tubes out on the tray and place the lid over top to compress. Lift up the lid and the membranes will likely be attached to the lid.
7. The fluid in the bottom of the tray can be used to mix with Biomaterials or wet your collagen membrane before placement. You can also dice up the A-PRF+ membranes and mix with cortico-cancellous bone like Raptos.