Is peripheral access for apheresis procedures underutilized in clinical practice?—A single centre experience

The Choosing Wisely campaign has stimulated clinicians to think about the appropriateness of various tests and procedures, compelling physicians to make smarter, safer and more effective choices for high quality patient care and to reduce healthcare cost. The American Society for Apheresis (ASFA) strives to advance apheresis medicine through education, evidence‐based practice, research and advocacy. To complement these shared missions, ASFA created a working group, consisting of representatives from the various ASFA committees, to produce recommendations for apheresis medicine that reflect the Choosing Wisely guiding principles. A diverse group of ASFA physician and allied health members reviewed, rated and ranked 9 original draft proposals. Additional revisions and refinements were made prior to external review and adoption of five final recommendations by the ASFA Board of Directors. The ASFA Choosing Wisely recommendations encourage apheresis practitioners, patients and donors to discuss and prioritize best clinical practices that avoid harm and waste while optimizing clinical benefit.

Section: Resultsmentioning

confidence: 99%

Choosing Wisely for apheresis

Connelly‐Smith

Tanhehco

Chhibber

et al. 2018

“…Prior to the implementation of SN‐TPE, 25% of our patients received VAD placement for TPE since they lacked two adequate veins for access. Other centers have successfully used peripheral access for the majority of their procedures . In cases where dual access is not feasible, SN‐TPE can assist in reducing the rate of VAD placement further as the criteria is for only one adequate vein, thus decreasing the risks of thrombosis or blood stream infections.…”

Section: Discussionmentioning

confidence: 99%

Single‐needle: an effective alternative to dual‐needle peripheral access in therapeutic plasma exchange

Doggett

Session-Augustine

Roig

et al. 2018

Apheresis treatments, which involve the removal of a component of blood, generally require one access and one return line to continuously draw and return blood into the extracorporeal circuit. At our center, we prefer to use peripheral venous access to avoid central line‐related complications, especially infection. Motivated by patient‐centered care, the single‐needle (SN) option for therapeutic plasma exchange (TPE) offered on the Spectra Optia (Terumo BCT, Lakewood, CO) was evaluated. Five patients underwent procedures using both SN and dual‐needle (DN) plasma exchange procedures using the Spectra Optia. TPE procedures ran a median of 51 (range:10‐102) minutes longer using the SN‐TPE option. Inlet flow rates, plasma removal efficiency, and incidence of citrate reactions were similar between SN‐ and DN‐procedures. Patients reported great satisfaction with SN‐TPE.

“…Although peripheral venous access is often considered the first option for chronic outpatient therapeutic plasma exchange (TPE), many patients may require a central venous access device . Implantable vascular access devices, which impose less of a burden on patient lifestyle than conventional apheresis catheters, have attracted increasing interest for therapeutic apheresis despite inferior whole blood and plasma flow rates compared to catheters for TPE in adults .…”

Section: Introductionmentioning

confidence: 99%

Performance characteristics of the PowerFlow apheresis port: Early experience

Garrity

Graves

Linden

et al. 2019

We prospectively evaluated the Bard PowerFlow Implantable Apheresis IV Port in four patients undergoing outpatient therapeutic plasma exchange over 18 to 97 days. Three had bilateral internal jugular access ports, and one had a single left internal jugular access port for the inlet line with return via antecubital vein. Two patients receiving 5% albumin as replacement fluid achieved peak inlet flow of 99 ± 5 mL/min and 101 ± 6 mL/min, and peak plasma flow of 53 ± 6 and 47 ± 6 mL/min, respectively. Two patients receiving plasma as replacement fluid achieved peak inlet flow of 46 ± 7 and 85 ± 4 mL/min and peak plasma flow of 27 ± 3 and 35 ± 4 mL/min, respectively. Apheresis nurses accessed the ports on the first attempt in all procedures. Pressure alarms occurred in 6 of 47 procedures and were easily resolved by lowering the inlet rate by 10% in 5 of them. The PowerFlow shows promise as an implantable venous access device for apheresis.