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Infusion Basics

Many medications to treat bleeding disorders use a method called infusion, which means the medication is injected directly into the vein. If you or your child uses clotting factor replacement therapy, learning how to infuse is an important part of managing a bleeding disorder. Being confident in infusion means you can treat bleeds early, which can help lessen the long-term effects on your health. Additionally, learning to infuse can reduce trips to the hospital or hemophilia treatment center (HTC) for treatment. 

The Basics of Infusion  

What is infusion? Infusion is a treatment given through the vein, directly into the blood where it is needed. Learning to infuse is a process that your health care provider and your HTC team will help you with, making sure your questions are answered. You will practice the steps for safe infusion together with the HTC team before you infuse by yourself. You can also contact your HTC team with questions as they come up and review the steps here: 

Setting the Stage for Safe Infusion

Because infusion is often done regularly, it’s important to have good habits around organization and cleanliness when planning to infuse. This is important for reducing the chance of infection. There are universal precautions everyone who infuses should take to lessen risk of infection to you and your household.  

  • The space for infusions should be clean and orderly  

  • Clean your space before you begin the infusion  

  • Wash your hands and arms up to the elbow with soap and warm water  

  • Wear gloves during the infusion and after finishing the infusion throw away used supplies  

  • Put used needles and bloody gauze in your sharps container  

  • If you spill blood in the infusion space, use chlorine bleach to clean it 

Throughout the infusion process, pay close attention to what needs to be clean and what needs to be sterile. Clean means there’s no dirt and the number of germs has been reduced. Sterile means that no germs exist. This is important for reducing the chance of infection. 

How to keep your infusion supplies clean and sterile:  

  • The infusion needle must be kept sterile
    • The needle should come in a sterile package
    • If the needle touches anything (even a table that has been cleaned), the needle is no longer sterile and needs to be thrown away
  • Always use sterile alcohol pads, or single-use cloths wet with an alcohol mixture
  • Never reuse or share needles

The following steps will guide you through the entire process of self-infusion. 

Prepare the Supplies and Work Area 

  • Gather supplies:
    • Factor product
    • Syringes
    • Sterile needles
    • Sterile alcohol pads
    • Tourniquet
    • Gauze pads
    • Adhesive bandages
    • Clean cloth or disposable pads for work area (optional)
    • Skin-numbing preparation (if recommended by your HTC)
    • Gloves (if needed)
    • Sharps container
    • Treatment log
  • Ensure infusion area has adequate lighting.
  • Clean your work area before you begin using a sterile alcohol pad. If you would like, you can also place down a clean cloth or disposable pad to work on.
  • Wash your hands and arms up to the elbow with soap and warm water.
  • Put on gloves (wearing gloves is required if you have a port or for anyone helping with your treatment but is otherwise optional).
  • Mix factor and prepare syringe per package guidelines.
  • Select a vein (see below for more tips on finding a vein)

Prepare the Site

  • Cleanse the site in a circular motion from inside to outside using a sterile alcohol pad.
  • Allow to dry. Do not touch the cleansed site prior to needle insertion.

Perform the Infusion

  • With the angled surface (known as the bevel) of the needle up insert the needle in at an approximately 30-degree angle.
  • Once the needle has entered the skin you can adjust the needle for the depth of the vein.
  • Pull back on the syringe slightly to check for a blood return. A blood return is when you pull back on the syringe slightly and blood enters the tubing connecting the needle to the syringe. A blood return indicates the needle is in the vein.
  • Release the tourniquet.
  • Gently push the factor into the vein while watching the insertion site for signs of infiltration, which is where the factor replacement product leaks out of the vein. Common signs of infiltration are swelling, redness, and pain at the infusion site. If you see signs of infiltration, stop infusing and remove the needle.
  • Infuse the factor over the recommended time per product information.
  • Once all the factor is infused remove the needle and dispose of the needle in your sharps container.

Post Infusion Care and Cleanup

  • Apply pressure to the infusion site using a gauze pad once completed and keep pressure for a minimum of 5 minutes. Then apply a bandage.
  • If you spilled factor or if there is blood on your work area, use chlorine bleach to clean it.
  • Document your infusion in your treatment log.
    If you wan more information about documenting your infusions, please go to Treatment Logs.

You Will Soon Be a Pro at Finding a Vein  

Finding a vein for infusion can be hard. With these suggestions, you can be more prepared and confident whether it is your first time infusing or you’ve been infusing for years. 

Here are some tips for finding a vein:

  • Find a comfortable position with your limb resting on a firm surface.
  • Use a tourniquet to assess veins for infusion site and needle selection.
    • Using a tourniquet will allow the vein to become full and larger feeling. Place the tourniquet several inches above the desired infusion site.
    • If accessing veins in the arms, make a fist or dangle your arm which will allow the veins to dilate.
  • Use your finger to feel for and trace the direction of the vein.
  • Finding a Vein Can Be Tricky. Here are some tips for finding a vein:
    • Gently slap the skin in the area of the desired infusion site.
    • Apply a warm washcloth to the desired infusion site (Remember to clean the area again prior to infusion).
    • Drink water leading up to the infusion.

Using a Central Venous Access Device (CVAD)1,2  

When infusing is difficult, some people may decide to use a central venous access device (CVAD.) A CVAD is a device that is surgically implanted under the skin and connected directly to a vein. This allows a person to inject the medication into the CVAD rather than having to inject directly into the vein. It is used more commonly in children, but adults can also find it useful. Higher risks of infection and blood clots forming in the vein could be problems when using a CVAD.  

Several types of CVADs are available, but your health care provider and HTC team will discuss the type of CVAD that is right for you or your child. When placing these devices, factor treatment is needed to avoid bleeding. The CVAD will need ongoing attention. Flushing of ports will help keep the infusion site clean and lessen risk of infection. 

Here are some of the CVADs that are available:  

  • Port (internal CVAD). With minor surgery, a port is placed just under the skin in the chest area. At the time of infusion, a special needle connects to the vein by catheter. The port, most commonly the Port-A-Cath version, can be used for years without dressings or external lines needed.

  • Nontunneled (external) central venous catheter. An external catheter is also inserted into a vein in the chest area. Unlike the internal CVAD port, an external catheter can only be used for a short time. Infusion therapy is injected into a cap at the end of the catheter. Dressings cover the cap to prevent infection when not in use. 

  • Tunneled central venous catheter. The tunneled catheter is also inserted under the skin in a vein at the chest area, but the neck area is also a possible site. The catheter’s outside end is used for infusions and can be used for more than one year. Common versions in use include the Hickman and Broviac catheters. 

  • Peripherally inserted central catheter (PICC). This catheter is placed in an arm vein with connection to a large blood vessel in the chest. They can be easily inserted, and the outside end of the catheter is used to infuse.  They can only be used for a short period of time.



  1. Santagostino, E., & Mancuso, M. E. (2008). Barriers to primary prophylaxis in hemophiliac children: the issue of the venous access. Blood transfusion = Trasfusione del sangue, 6 Suppl 2(Suppl 2), s12–s16.

  2. Titapiwatanakun R, Moir C, Pruthi RK, Stavlo PL, Schmidt KA, Rodriguez V. Central venous access devices for paediatric patients with haemophilia: a single-institution experience. Haemophilia. 2009 Jan;15(1):168-74. doi: 10.1111/j.1365-2516.2008.01906.x. PMID: 19149849