Access in therapeutic apheresis.

Various modes may be used to perform apheresis, such as plasma exchange, plasmapheresis, immunoadsorption, and blood perfusion. The vascular access used for acute procedures may be sufficiently supplied by two peripheral veins or catheters placed in the femoral vein or the right internal jugular vein. For chronic treatment it might be necessary to place an arteriovenous fistula or graft. The risks involved when using the various accesses is discussed, as is the insertion technique of the femoral vein catheter. The insertion of catheters into larger vessels is preferably controlled by ultrasound guidance. The incidence of adverse events due to access problems is about 0.4%. Once in every 1000 planned procedures, a problem with the access will cause an interruption of apheresis. Other complications that may occur are infections and thrombosis. Long-term use of particularly subclavian vein catheters more frequently results in stenosis than the use of other accesses. The placement of a femoral vein catheter is facilitated by outward rotation of the leg. In addition, other practical suggestions are given.