Clinical Checklists
Standardized checklists for safe hirudotherapy practice
Last Updated: March 5, 2026Reviewed by: Andrei Dokukin, MD
Last updated: March 14, 2026
Standardized checklists reduce errors and ensure consistent adherence to clinical guidelines. These checklists are derived from published protocols (Mumcuoglu et al., 2014; Whitaker et al., 2004) and institutional best practices from academic medical centers that routinely perform leech therapy.
Pre-Procedure Checklist
Before First Leech Application
Patient Assessment:
- ☐ Clinical indication documented
- ☐ Contraindication screening completed
- ☐ Allergy history reviewed (antibiotics, latex, prior leech reactions)
- ☐ Medication review (anticoagulants, NSAIDs held per protocol)
- ☐ Prior leech therapy history assessed
Documentation:
- ☐ Signed informed consent in medical record
- ☐ Off-label status disclosed (if applicable)
- ☐ Baseline photographs taken
- ☐ Leech source and lot number documented
Laboratory:
- ☐ CBC with differential (Hgb ≥8 g/dL)
- ☐ PT/INR (INR ≤3.0)
- ☐ aPTT (≤2x upper normal)
- ☐ Type and screen (surgical patients)
- ☐ BMP (multi-day therapy patients)
Prophylaxis:
- ☐ Antibiotic prophylaxis initiated (≥1 hour before)
- ☐ Drug, dose, route documented
- ☐ Allergy-appropriate regimen selected
- ☐ Emergency supplies verified (epinephrine, hemostatics)
- ☐ Biohazard waste container available
Intra-Procedure Checklist
During Leech Application
Setup:
- ☐ Room temperature 72-77°F
- ☐ "No Fragrances" notice posted
- ☐ PPE donned (nitrile gloves, gown if splash risk)
- ☐ Site cleansed with warm water only
- ☐ Application sites marked
- ☐ Absorbent pads positioned
Application:
- ☐ Leech health verified (active, responsive)
- ☐ Number of leeches per physician order
- ☐ Attachment confirmed (peristaltic waves visible)
- ☐ Patient NOT left unattended
- ☐ Vital signs monitored per protocol
- ☐ Feeding duration documented per leech
Post-Procedure Checklist
After Leech Detachment
Immediate:
- ☐ Leech disposed in 70% ethyl alcohol
- ☐ Death confirmed, transferred to biohazard container
- ☐ Wound dressed (gauze, no pressure)
- ☐ Post-detachment vital signs recorded
- ☐ Bleeding assessment at 30 min and 2 hours
- ☐ Session documented (# leeches, sites, duration, blood loss)
Discharge / Follow-Up:
- ☐ Written wound care instructions provided
- ☐ Return precautions reviewed (infection signs)
- ☐ Antibiotic prophylaxis plan confirmed (continue duration)
- ☐ Pain management instructions (acetaminophen; avoid NSAIDs)
- ☐ Follow-up appointments scheduled (24h, 72h, 1wk, 4wk)
- ☐ Contact information for emergencies provided
Serial Treatment Checklist
Multi-Day Surgical Leech Therapy
- ☐ Cumulative blood loss tracked across all sessions
- ☐ Hematocrit monitored every 4-8 hours
- ☐ Blood products available (type and screen current)
- ☐ Tissue viability assessment each session (color, Doppler, capillary refill)
- ☐ Antibiotic prophylaxis continued throughout course
- ☐ Post-course summary documented (total sessions, total leeches, total blood loss)
- ☐ Follow-up schedule extends 26 days post-last application