Plasmapheresis.pptx

demonstration on Plasmapharesis, its definition, indications, contraindication, steps, after care, complications. for Medical, Lab techinicians, AHS, B.Sc & M.Sc Nursing, DGNM & PC BSc (N)

1. PLASMAPHERESIS PRESENTED BY: Mrs . Edvina Princy K Assistant Professor, SRM Trichy College of Nursing, Trichy .

2. DEFINITION Plasmapheresis is a blood purification procedure. It involves removal of blood from the body and its treatment and the return of components of blood to the body after the extraction of plasma.

3. PURPOSE In an autoimmune disease the immune system attacks the body’s own tissues. Plasmapheresis is used to remove antibodies from the bloodstream thereby preventing them from attacking the targets. It does not directly affect the immune system’s ability to make antibodies and therefore offers temporary benefit.

4. INDICATIONS Major indications Guillain-Barré syndrome Myasthenia gravis Chronic inflammatory demyelinating polyneuropathy Thrombotic thrombocytopenic purpura Idiopathic thrombocytopenic purpura Multiple sclerosis

5. INDICATIONS CONTD.. Minor indications Hyperviscosity syndrome Wegener’s granulomatosis Lambert Eaton syndrome Antiphospholipid antibody syndrome Pemphigus vulgaris HIV- related neuropathy

6. CONTRAINDICATIONS Hemodynamic instability Sepsis Conditions causing inability to tolerate fluid shift(anemic patients and patients with cardiovascular disease) Inability to tolerate Central line placement Severe hypocalcemia

7. PRINCIPLES Principle of centrifugal separation. Centrifugation is a technique that helps to separate mixtures by applying centrifugal force. Centrifugal aspheresis separate plasma from cellular components based on density.

8. PRINCIPLES CONTD.. Principle of membrane separation The membrane separation process is based on the presence of semi permeable membranes. The principle is quite simple: the membrane acts as a very specific filter that will let water flow through, while it catches suspended solids and other substances. Membrane aspheresis separate plasma from cellular components based on molecular size.

9. ARTICLES REQUIRED Central line set Saline flush Suture Scalpel Sterile dressing Citrate solution Pressure bag to attach monitoring Automated centrifuge or semipermeable membrane FFP or albumin Cell separator Sterile field, gloves, gown and mask

10. TYPES

11. PRE- PROCEDURE Take patient consent Good nutrition and plenty of rest to be provided to make the procedure less stressful. Discontinue medications as ordered by the physician. Set up sterile trolley. Confirm the placement of Central venous line Position the patient in reverse trendelenburg position in accordance with the patient comfort.

12. PROCEDURE Establish a central venous line as central veins allow higher flow rates and are more convenient for repeat procedures. Any hepawin that may be present in each of the two lumina of a central venous catheter is removed. Laboratory studies including complete blood count (CBC), calcium and fibrinogen are ordered and specimens are sent from the draw lumen.

13. PROCEDURE CONTDD.. A flush with 10ml of normal saline is placed in a draw lumen. The draw and return lumen are then connected to the tubing, which is previously primed with normal saline; however if the patient weighs less than 20 kilograms then the draw and return tubing is primed with packed red blood cells instead of normal saline. The total blood volume is then estimated from the height and weight of the patient.

14. PROCEDURE CONTD... Plasma volume is then calculated as follows: . TBV×(1- hematocrit) Are replacement product is chosen. The total volume of the desired replacement product is enetred- usually either 1plasma volume(40ml/kg) or 1.5 plasma volume(60ml/kg). A centrifuge speed is determined by the software on the basis off the data entered.

15. PROCEDURE CONTD .. The device then draws whole blood through the draw lumen to the centrifuge. Plasma is then separated buy the centrifuge and then collected for discard. RBCs are also separated buy the centrifuge, then returned to the patient along with the previously selected colloid of either albuminor fresh frozen plasma(FFP).

16. PROCEDURE CONTD... After the desired amount of plasma is removed, the machine is disconnected from the patient and heparin is instilled into each catheter lumen to prevent clotting until the lumen is accessed again. A post plasma exchange fibrinogen level is checked if albumin was used as the replacement product to assess whether the patient has become severely hyperfibrinogenemic

17. COMPLICATIONS Immunosuppression Hypocalcemia Hypomagnesemia Hypothermia Hypotension hyperfibrinogenemia Hematoma Transfusion reaction

18. DOCUMENTATION

19. AFTERCARE The patient may experience dizziness, nausea, numbness, tingling or lightheadedness during or after the procedure. These effects usually pass quickly allowing the patient to return to normal activities the same day.