The following text comes from www.HemophiliaEmergencyCare.com. To determine specific factor dosages for a given patient, go to the web site and click on 'Get Factor Dosage Orders'.

Venous Access
 

Sites for access

Intravenous access for a person with hemophilia is basically the same as for any patient. The use of 23 gauge or 25 gauge "winged" needles is preferable, especially for children. Sites to consider for a peripheral IV include:

- dorsum of the hands

- antecubital fossa (caution in infants due to the risk of compartment syndrome)

- dorsum of feet (infants and children)

- scalp veins (infants only)

Groin and neck veins are contraindicated except in life-threatening situations.

The patient's IV should not be started in the affected limb. The injured area should be minimally manipulated, if at all.
 

Venous access device

Some venous access devices currently used in hemophilia care include:

- Port or peripheral port - access with non-coring needle as per your institution's procedure

- External central catheter - Hickman, Broviac, or Groshong; access per your institution's procedure

- P.I.C.C. line - access per your institution's procedure

Heparin flush

It is recommended to do a final flush with heparin for any venous access device (except for Groshong's which are only flushed with normal saline). Check with the parent or the patient's institution for the amount of heparin flush to use. If these options are not available, use your institution's procedure for the amount and concentration of heparin. This small amount of heparin will not harm the patient (remember - you've just given him factor). The access device needs to stay patent; this is accomplished with the heparin.

The patient on prophylaxis

Some patients with hemophilia now receive prophylactic doses of factor replacement on an every-other-day or 2-3 times a week routine schedule. This should be asked of the patient. These patients usually have venous access devices for infusions. So, always check to see if the patient has a venous access device before starting a peripheral infusion.