Judy Kauffman, RN, CPNP Andrew Wilson, RN, CPHON Kansas City Regional Hemophilia Center
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Transcript of Judy Kauffman, RN, CPNP Andrew Wilson, RN, CPHON Kansas City Regional Hemophilia Center
![Page 1: Judy Kauffman, RN, CPNP Andrew Wilson, RN, CPHON Kansas City Regional Hemophilia Center](https://reader035.fdocuments.in/reader035/viewer/2022070400/56812f0b550346895d94a759/html5/thumbnails/1.jpg)
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
![Page 2: Judy Kauffman, RN, CPNP Andrew Wilson, RN, CPHON Kansas City Regional Hemophilia Center](https://reader035.fdocuments.in/reader035/viewer/2022070400/56812f0b550346895d94a759/html5/thumbnails/2.jpg)
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
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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
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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
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• 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
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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.
Body Wt. Kg Body Wt. lbs Max Volume (ml)
1 2.2 2.5
5 11 10
10 22 20
21-25 45-55 42-50
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Preliminary Results
Subject Veni Fac Veni Inh CVL Fac CVL Inh
#1 FVIII 1% 0.09 BU FVIII 1% 0 BU
#2 FVIII <1% FVIII <1%
#3 FVIII 1% 0 BU FVIII 1% 0 BU
#4 FVIII 7% 0BU FVIII 7% 0 BU
#5 FVIII <1% 47.2 BU FVIII <1% 47 BU
#6 FVIII 62% 0 BU FVIII 48% 0 BU
#7 FIX 7% 0 BU FIX 5% 0 BU
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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%
Subject Veni Fac Veni Inh CVL Fac CVL Inh
#6 FVIII 62% 0 BU FVIII 48% 0 BU
![Page 9: Judy Kauffman, RN, CPNP Andrew Wilson, RN, CPHON Kansas City Regional Hemophilia Center](https://reader035.fdocuments.in/reader035/viewer/2022070400/56812f0b550346895d94a759/html5/thumbnails/9.jpg)
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?