Putensen Daniel, Leverett David, Patel Bhavika, Rivera Jasmin
University College London Hospitals, Haematology-Apheresis, London, United Kingdom.
J Clin Apher. 2017 Dec;32(6):553-559. doi: 10.1002/jca.21508. Epub 2016 Sep 15.
The majority of reports regarding general vascular access choices for apheresis procedures argue that peripheral venous access should be considered first. However, the clinical reality appears to be different. While some procedures mandate central vascular access (e.g., therapeutic apheresis procedures in critically ill patients) and in some cases it is the patient's preference, we propose that the majority of elective procedures can be successfully performed peripherally.
To establish the feasibility and suitability of peripheral access for different apheresis procedures, undertaken in elective or emergency settings.
The choice of vascular access devices and cannulation sites were analysed retrospectively from all apheresis procedures performed between January 2014 and December 2015 at a single institution.
Over 2 years a total of 3714 procedures were performed on 1061 patients. Absolute number of procedures (percentage) done peripherally: autologous and allogeneic hematopoietic progenitor cell harvest-400 (88%) and 458 (97%) respectively; mononuclear cell harvest-88 (93%); automated red cell exchange-1954 (80%); therapeutic plasma exchange-766 (26%); white blood cell depletion-48 (71%). Choice of vascular access for all procedures (absolute number [percentage]): peripheral and ultrasound-guided peripheral deep vein cannulation-2683 (72%); central venous catheter access: femoral-331 (9%); jugular-511 (14%); subclavian-2 (<1%); double-lumen port-187 (5%). Peripheral access in all apheresis procedures (emergency and elective) was 72%; for purely elective procedures this number increased to 80% to 97%, depending on the procedure.
In our institution the majority of elective apheresis procedures are successfully performed using peripheral access.
大多数关于单采程序中一般血管通路选择的报告认为，应首先考虑外周静脉通路。然而，临床实际情况似乎并非如此。虽然有些程序要求中心血管通路（例如，重症患者的治疗性单采程序），而且在某些情况下这也是患者的偏好，但我们认为大多数择期程序可以通过外周途径成功进行。
确定在择期或紧急情况下，不同单采程序采用外周通路的可行性和适用性。
回顾性分析了2014年1月至2015年12月在一家机构进行的所有单采程序中血管通路装置的选择和插管部位。
在2年多的时间里，对1061例患者共进行了3714次程序。外周进行的程序绝对数（百分比）：自体和异体造血祖细胞采集分别为400次（88%）和458次（97%）；单核细胞采集88次（93%）；自动红细胞置换1954次（80%）；治疗性血浆置换766次（26%）；白细胞去除48次（71%）。所有程序的血管通路选择（绝对数[百分比]）：外周及超声引导下外周深静脉插管2683次（72%）；中心静脉导管通路：股静脉331次（9%）；颈静脉511次（14%）；锁骨下静脉2次（<1%）；双腔端口187次（5%）。所有单采程序（紧急和择期）中外周通路的比例为72%；对于纯择期程序，这一比例根据程序不同增至80%至97%。
在我们机构，大多数择期单采程序通过外周通路成功进行。
