Ritzenthaler Thomas, Beraud Mickael, Gobert Florent, Dailler Frédéric
Service de Réanimation Neurologique, Hospices civils de Lyon, Bron Cedex, France.
Terumo BCT Europe NV, Zaventem, Belgium.
J Clin Apher. 2019 Feb;34(1):33-38. doi: 10.1002/jca.21669. Epub 2018 Nov 8.
An efficient vascular access is mandatory for the proper conduction of therapeutic plasma exchanges (TPE). Peripheral and central venous catheters may be used, with respective advantages and limitations. In this study, vascular access devices (IV catheter, dialysis cannula, central venous catheter) and anatomic vein characteristics were evaluated.
From January to June 2016, 162 TPE in 29 patients were reviewed. Only TPE using centrifugation method (Spectra Optia apheresis system) were evaluated. Volume exchanged, procedure duration, mean flow rate, number of inlet, and return pressure pauses were recorded. Site, width, and depth of punctured veins were studied.
Median exchange volume planned was 3500 mL, and 152 (94%) procedures could be completed. Peripheral venous catheter was inserted in 103 (64%) cases (IV catheter: 61, dialysis cannulae: 42). Ultrasound guidance was used in 12 (11%) cases. Median procedure duration was shorter with central venous catheter (94 minutes), rather than dialysis cannula (133 minutes) or IV catheter (133 minutes). Median numbers of inlet pressure pauses were lower with central venous catheter (0) and dialysis cannulae (6), rather than IV catheter (10). There were no complications with peripheral venous access. There were no anatomic differences between catheterized veins with IV catheter or dialysis cannula.
The use of peripheral venous access is possible in most of TPE, for emergency and during maintenance therapy. Dialysis cannulae are good compromise between classic IV catheters and central venous catheters, as it allows high flow rates, are easy to insert and associated with few complications.
有效的血管通路对于治疗性血浆置换（TPE）的顺利进行至关重要。外周静脉导管和中心静脉导管均可使用，各有其优缺点。本研究对血管通路装置（静脉留置针、透析套管、中心静脉导管）及解剖学静脉特征进行了评估。
回顾性分析2016年1月至6月期间29例患者的162次TPE治疗。仅评估采用离心法（Spectra Optia血液成分分离系统）进行的TPE治疗。记录置换量、操作时间、平均流速、进液次数及回压暂停次数。研究穿刺静脉的部位、宽度及深度。
计划置换量中位数为3500 mL，152例（94%）治疗可完成。103例（64%）采用外周静脉导管（静脉留置针：61例，透析套管：42例）。12例（11%）使用超声引导。中心静脉导管操作时间中位数较短（94分钟），而非透析套管（133分钟）或静脉留置针（133分钟）。中心静脉导管进液压力暂停次数中位数较低（0次），透析套管为6次，静脉留置针为10次。外周静脉通路未出现并发症。使用静脉留置针或透析套管的穿刺静脉在解剖学上无差异。
在大多数TPE治疗中，无论是紧急情况还是维持治疗期间，外周静脉通路均可行。透析套管是经典静脉留置针和中心静脉导管之间的良好折衷选择，因为它允许高流速、易于插入且并发症较少。
