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Judy Kauffman, RN, CPNP Andrew Wilson, RN, CPHON Kansas City Regional Hemophilia Center

A Study Comparing Factor Level and Inhibitor Titer Testing Results Drawn from Central Venous lines and Venipuncture. Judy Kauffman, RN, CPNP Andrew Wilson, RN, CPHON Kansas City Regional Hemophilia Center. The Problem.

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Judy Kauffman, RN, CPNP Andrew Wilson, RN, CPHON Kansas City Regional Hemophilia Center

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  1. A Study Comparing Factor Level and Inhibitor Titer Testing Results Drawn from Central Venous lines and Venipuncture Judy Kauffman, RN, CPNP Andrew Wilson, RN, CPHON Kansas City Regional Hemophilia Center

  2. The Problem • Many opinions about whether accurate factor levels/ inhibitor titers can be obtained from CVLs • Children with poor venous access hospitalized after venipuncture? • The big issue: parents not willing to participate in research due to requirement for peripheral lab draws

  3. Literature Review • Multiple studies comparing CVL vs. venipuncture for drug levels (MTX, abx) • Most show that technique used to draw the CVL specimen determines accuracy

  4. Comparison of Coagulation Testing • McLaren, et al (2000) & Humphries and Baldwin (2009) showed that PT, aPTT, fibrinogen can be accurately drawn from CVL • Hinds, et al (2002) concluded that PT, aPTT drawn from CVL were not accurate • Lindley, et al (1994) compared FVII levels drawn from CVL with venipuncture and said that they could be compared

  5. Manco-Johnson, et all (2000) provided the protocol for the study • Method determines results • CVL should be flushed w/ 10 ccs NS, then 10ccs of blood wasted before specimen is drawn • All CVL specimens should be treated with heparinase • With this method inhibitor titers drawn from CVLs are accurate

  6. Maximum Blood Draw Volumes for Pediatric Patients • Policy is 2.5% total blood volume, can be increased with MD approval. Adapted from Children’s Hospital and Regional Medical Center Lab, Seattle, WA. 2001.

  7. Preliminary Results

  8. Outlier • Peripheral Draw • 1:10= 48% • 1:20= 62% • Low 1:10= 59% • CVL Draw • 1:10= 47% • 1:20= 48% • Low 1:10= 54%

  9. Goal of Study • To show whether factor levels and inhibitor titers can be accurately drawn from CVLs • Will need to expand this pilot study to enroll enough subjects to achieve significance • Might be a good multi-center study?

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