Ultrasound‐guided peripheral venous access for therapeutic apheresis procedures reduces need for central venous catheters

Abstract

Therapeutic and donor apheresis requires adequate vascular access to achieve inlet flow rates of ∼50-100 mL/min. While central dialysis-type venous catheters can usually provide such access, their use includes several associated risks. Some of these risks can be avoided or diminished if adequate peripheral venous access can be established. Some patients have adequate peripheral veins for apheresis that cannot be readily identified visually or by palpation. We hypothesized that ultrasound-guided peripheral venous access would benefit such patients and would lead to placement of fewer central venous catheters. The technique of ultrasound-guided peripheral access for apheresis has been in use at Houston Methodist Hospital since 2012. We performed a prospective review of patients undergoing inpatient and outpatient apheresis at Houston Methodist Hospital from July 1, 2015 to September 30, 2015, to assess its benefit. During this time, we performed 831 procedures on 186 patients, including 787 therapeutic plasma exchanges, three red blood cell exchanges, 41 peripheral stem cell collections. Ultrasound-guided vascular access was used for 68 procedures (8% of all procedures), including 62 therapeutic plasma exchanges, 4 peripheral stem cell collections, and 2 red blood cell changes. Use of ultrasound-guided peripheral access prevented the placement of central venous catheters in 37 (20%) patients, demonstrating its utility in a busy transfusion service.

Leukocytapheresis in nonmobilized donors for cellular therapy protocols: Evaluation of factors affecting collection efficiency of cells

“…This result may suggest that, if possible, peripheral veins should be used as vascular access for leukocytapheresis in adult patients not only because the CE1 of MNCs was improved but also to avoid risks associated with central line placement . Knowledge of experienced nurses is important when evaluating vascular access in these donors as well as the implementation of ultrasound‐guided placement of peripheral venous access …”

Vascular access for therapeutic plasma exchange

“…The risks of peripheral vascular access include hematoma formation, nerve damage, patient discomfort, and sclerosis of veins or arteries . In individuals with nonpalpable or difficult vascular anatomy, an ultrasound can aid in establishing peripheral vascular access . Single‐institutional experiences with ultrasound demonstrated that peripheral vein cannulations increased with a reduction in the placement of CVCs …”

A successful model to learn and implement ultrasound‐guided venous catheterization in apheresis

“…Other studies reported that peripheral venous access was always considered before CVC placement; however, <5% of apheresis procedures were performed using peripheral veins . A recently published study showed how ultrasound guidance prevented CVC when implemented in part of the apheresis department . In this study, we included the whole department and present a systematic training program for the implementation.…”