Influence of vascular access devices upon efficiency of therapeutic plasma exchange

Abstract

Background An efficient vascular access is mandatory for the proper conduction of therapeutic plasma exchanges (TPE). Peripheral and central venous catheters may be used, with respective advantages and limitations. In this study, vascular access devices (IV catheter, dialysis cannula, central venous catheter) and anatomic vein characteristics were evaluated. Method From January to June 2016, 162 TPE in 29 patients were reviewed. Only TPE using centrifugation method (Spectra Optia apheresis system) were evaluated. Volume exchanged, procedure duration, mean flow rate, number of inlet, and return pressure pauses were recorded. Site, width, and depth of punctured veins were studied. Results Median exchange volume planned was 3500 mL, and 152 (94%) procedures could be completed. Peripheral venous catheter was inserted in 103 (64%) cases (IV catheter: 61, dialysis cannulae: 42). Ultrasound guidance was used in 12 (11%) cases. Median procedure duration was shorter with central venous catheter (94 minutes), rather than dialysis cannula (133 minutes) or IV catheter (133 minutes). Median numbers of inlet pressure pauses were lower with central venous catheter (0) and dialysis cannulae (6), rather than IV catheter (10). There were no complications with peripheral venous access. There were no anatomic differences between catheterized veins with IV catheter or dialysis cannula. Conclusion The use of peripheral venous access is possible in most of TPE, for emergency and during maintenance therapy. Dialysis cannulae are good compromise between classic IV catheters and central venous catheters, as it allows high flow rates, are easy to insert and associated with few complications.

Vascular access in therapeutic apheresis: One size does not fit all

“…Antecubital fossa and larger arm veins such as cephalic or basilic are recommended for drawing blood from the patient; whereas, we can use smaller veins for return. Ritzenthaler et al evaluated the influence of vascular access devices and anatomic characterization of veins upon TPE efficiency [15]. They used two different PVCs: IV catheter (16 or 18 G) or dialysis cannula (18G).…”

“…In conclusion, PVC was chosen to be the first option in TPE vascular access in inpatient and outpatient settings, as it is more convenient and has lesser risk of complications. Besides, US-guided peripheral access was reported to help prevent CVC insertion in up to 10% of the procedures [15]. [20]…”

Vascular access practices for therapeutic apheresis: Results of a survey

“…An international apheresis registry found the highest rates of access problems with peripheral venous access and AVF or AVG use . A single center study observed higher rates of inlet pressure pauses and longer procedure duration with peripheral venous access . Low inlet pressure alarms with peripheral access may be due to vein collapse at the tip of the access needle .…”

Central venous catheters are associated with thrombosis among adult inpatients undergoing therapeutic plasma exchange

“…In a nationwide study of TPE, predictors of CVC use were obesity (18% vs. 16%, P = 0.017), concurrent hemodialysis (14% vs. 10%, P < 0.001), female sex (54% vs. 50%, and illness severity ( P < 0.001) 3 . CVC has been preferred over peripheral venous access due to access difficulties, longer procedural times, suboptimal blood flow, inadequate process volume, and decreased efficiency 2,7,40‐42 . Notwithstanding these challenges, peripheral venous access is associated with lower rates of adverse events 2,7,42 .…”

“…For this reason, the ASFA Choosing Wisely campaign recommends peripheral venous access over CVC 3,40 . Peripheral venous access could be optimized by ultrasound‐guided peripheral vein assessment as shown in a French study in which peripheral vein assessment by ultrasound allowed successful peripheral venous access in 64% of the procedures 41 . Ultrasound assessment should be considered as a strategy to increase peripheral access in eligible inpatients undergoing TPE.…”