Vascular access practices for therapeutic apheresis: Results of a survey

Tanhehco, Yvette C.; Zantek, Nicole D.; Alsammak, Mohamed; Chhibber, Vishesh; Li, Yanhua; Becker, Joanne; Wu, Ding Wen; Foster, Tisha

doi:10.1002/jca.21726

Cited by 15 publications

(22 citation statements)

References 43 publications

(49 reference statements)

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“…Prevention of infection is crucial, as sepsis is considered the most important single factor affecting mortality among patients with severe HGAP . Peripheral venous access with 16‐18‐gauge needle using basilic, brachiocephalic, or cephalic veins can be used to initiate TPE . However, in some situations, central line placement is often required if the peripheral access is not adequate or if there is another indication for a central line placement (ie, administration of vasopressor agents).…”

Section: Cases and Discussionmentioning

confidence: 99%

Therapeutic approaches in hypertriglyceridemia‐induced acute pancreatitis: A literature review of available therapies and case series

Joury

Alshehri

Mahendra

et al. 2019

J of Clinical Apheresis

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Hypertriglyceridemia-induced acute pancreatitis (HGAP) is the third most common etiology of acute pancreatitis. HGAP can be attributed to genetic disturbances in triglyceride metabolism or multiple secondary causes. Here, we presented three cases for HGAP and explored different therapeutic approaches for treating HGAP. A case series of three patients who presented with HGAP and underwent different therapeutic approaches was conducted. The first patient was a 37-year-old male who presented with nonsevere HGAP; he was treated with conservative therapy with insulin and heparin infusion, which resulted in clinical and laboratory improvement. The second patient was a 64-year-old male with human immunodeficiency virus on multiple highly active antiretroviral therapy. He presented with severe HGAP and multiorgan failure. After initiation of therapeutic plasma exchange, his HGAP resolved. The third patient was a 28-year-old male who presented with recurrent episodes of HGAP; his conservative therapy failed and was eventually escalated to therapeutic plasma exchange (TPE). HGAP can be attributed to genetic disturbances of lipid or secondary etiologies. A nonsevere form of HGAP can be managed with conventional therapy including insulin and heparin; however, severe HGAP may require TPE. K E Y W O R D S hypertriglyceridemia, pancreatitis, therapeutic plasma exchange

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Section: Cases and Discussionmentioning

confidence: 99%

Therapeutic approaches in hypertriglyceridemia‐induced acute pancreatitis: A literature review of available therapies and case series

Joury

Alshehri

Mahendra

et al. 2019

J of Clinical Apheresis

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“…While large bore (16-18 gauge) steel needles are used for both TP and apheresis procedures, the flow rate during TE is quite high at approximately 50-100 ml/min. 7 Single-needle access can be utilized for TE if adapter kits are available; otherwise, two large bore peripheral needles are required for TE. If peripheral access is not a viable option for a patient requiring TE, central venous catheters (CVCs) may be used.…”

Section: Erythrocytapheresismentioning

confidence: 99%

“…One important consideration before initiating TE is the requirement for adequate vascular access. While large bore (16–18 gauge) steel needles are used for both TP and apheresis procedures, the flow rate during TE is quite high at approximately 50–100 ml/min 7 . Single‐needle access can be utilized for TE if adapter kits are available; otherwise, two large bore peripheral needles are required for TE.…”

Section: Introductionmentioning

confidence: 99%

How do I…perform therapeutic phlebotomy?

Peedin

Karp

2021

Transfusion

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Background: Therapeutic phlebotomy (TP) is a well-established medical intervention that evolved from the historical practice of bloodletting. Methods: Patients who require TP are not infrequently told by their healthcare providers to "just go donate blood," but TP should always be offered in the context of a prescribed course of therapy. Providers can prescribe a course of TP for a number of indications, including hereditary hemochromatosis, polycythemia vera, iron overload, and testosterone replacement therapy. Results: A course of prescribed TP specifies that patients can be phlebotomized more frequently than volunteer blood donors and reassures patients that TP is being performed per the orders of their provider. Prescribed TP also facilitates two-way communication between the referring provider and the transfusion medicine (TM) physician overseeing the TP. The College of American Pathologists TM checklist describes several requirements regarding the documentation and performance of TP, and electronic medical record systems can be used to demonstrate compliance with these requirements. Conclusions: TM physicians should discuss the advantages of prescribing TP with providers who mutually care for patients requiring this intervention.

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“…Centrifugal apheresis involves lower blood flow rates, and enables the use of catheters with smaller diameters, and more flexible walls (such as peripheral catheters or standard triple lumen central venous catheters. Conversely, membrane filtration involves higher blood flow rates, which requires the use of larger diameter, stiffer catheters (such as standard dialysis catheters or single lumen central venous catheters) 25‐29 . Clinicians should be aware of, or consult the appropriate service for what modality of TPE is used at their center, so appropriate central venous access can be secured before initiation of TPE.…”

Section: Supportive Carementioning

confidence: 99%

Good practice statements (GPS) for the clinical care of patients with thrombotic thrombocytopenic purpura

Zheng

Vesely

Cataland

et al. 2020

Journal of Thrombosis and Haemostasis

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Background: Despite advances in treatment options for thrombotic thrombocytopenic purpura (TTP), there are still limited high quality data to inform clinicians regarding its management. Methods: In June 2018, the ISTH formed a multidisciplinary guideline panel to issue recommendations about treatment of TTP. The panel discussed 12 treatment questions related to both immune-mediated TTP (iTTP) and hereditary/congenital TTP (cTTP). The panel used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, including evidence-to-decision frameworks, to appraise evidence and formulate recommendations. Results: The panel agreed on eleven recommendations based on evidence ranging from very low to moderate certainty. For first episode and relapses of acute iTTP, the panel made a strong recommendation for the addition of corticosteroids to therapeutic plasma exchange (TPE), and a conditional recommendation for addition of rituximab and caplacizumab. For asymptomatic iTTP with low ADAMTS13, the panel made a conditional recommendation for rituximab outside of pregnancy, and for prophylactic TPE during pregnancy. For asymptomatic cTTP, the panel made a strong recommendation for prophylactic plasma infusion during pregnancy, but a conditional recommendation for plasma infusion or a wait and watch approach outside of pregnancy. Conclusions: The panel's recommendations are based on all the available evidence for the treatment effects of various approaches including suppressing inflammation, blocking platelet clumping, replacing the missing and/or inhibited ADAMTS13, and suppressing ADAMTS13 antibody production. There was insufficient evidence for further comparison of different treatment approaches, for which future high-quality

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Vascular access practices for therapeutic apheresis: Results of a survey

Abstract: Introduction: Obtaining vascular access (VA) is a critical part of the therapeutic apheresis (TA) treatment plan. Currently, there are no guidelines for VA decisionmaking and maintenance related to TA procedures. Materials and Methods: A 28-question survey to gather qualitative information

Cited by 15 publications

References 43 publications

Therapeutic approaches in hypertriglyceridemia‐induced acute pancreatitis: A literature review of available therapies and case series

Therapeutic approaches in hypertriglyceridemia‐induced acute pancreatitis: A literature review of available therapies and case series

How do I…perform therapeutic phlebotomy?

Good practice statements (GPS) for the clinical care of patients with thrombotic thrombocytopenic purpura

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