Canterbury DHB
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Use peripheral veins where possible, as these are the safest. Large antecubital fossa veins are ideal and need to be large enough for a 16 gauge needle and withdrawal flow rates of ~60 ml/minute. They also need to be capable of sustaining repeated cannulation. The apheresis nurse can advise on this issue. These veins must not be used for collecting blood samples.
If central venous access is required, a hard wall catheter must be used. A single lumen catheter is satisfactory if there is a good peripheral vein through which to give replacement fluids. Commonly, a double lumen renal dialysis catheter is used because often the patient may require central venous access for other reasons.
The responsibility of this lies with the Clinician caring for the patient. This is to ensure that the patient is fit to undergo the procedure. Particular account should be taken of pulse and blood pressure, cardiorespiratory status, and whether any severe autonomic neuropathy is present. These findings must be recorded in the patient’s notes. The following laboratory tests should be performed before each procedure: CBC, coagulation profile, sodium, potassium, calcium, glucose, creatinine. Other tests may be needed, depending on the patient’s condition.
Also see Clinical Lab. Haem. 1998. 20. 265-278 - Guidelines for the Clinical Use of Blood Cell Separators, prepared by a joint Working Party of the Transfusion and Clinical Haematology Task Forces of the British Committee for Standards in Haematology.
The medical examination should be performed by the paediatrician and recorded in the patient's/donor's notes.
All apheresis procedures must take place in an area with full paediatric resuscitation equipment, and personnel trained in its use must be available.
Therapeutic plasma exchange procedures require coordination with the apheresis nurses, paediatricians, and paediatric anaesthetist. As a result of these needs and possible concerns about the safety of the procedure in very small patients(<30 kg BWt), it may not always be possible to perform this procedure in Christchurch.
Continuous flow cell separators with minimal extracorporeal volume are preferred for children. Intermittent or discontinuous systems can be used but may require priming with homologous donor blood.
Good venous access is essential and often central lines are required.
Children who weigh less than 30 kg will require the apheresis extracorporeal lines to be primed with homologous donor blood. This blood should have a similar haematocrit to the patient’s, ideally be CMV negative and irradiated. All blood components in New Zealand are leuocodepleted.
If the procedure is lengthy, the replacement fluid should be warmed to prevent central body cooling.
Adverse effects to watch for especially in children <30 kg include:
This includes advice for replacement fluids in TTP/HUS, clotting factors, inhibitors and some rare metabolic disorders. Refer to:
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Topic Code: 5150
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