Authors (including presenting author) :
Yeung MW (1); Lo WPJ (1); Man MY (1); Shum HP (1)
Affiliation :
(1) Department of Intensive Care, Pamela Youde Nethersole Eastern Hospital
Introduction :
Therapeutic plasma exchange (TPE) is the therapeutic removal of pathological mediators bound with the patient's plasma. TPE might sometimes be urgently indicated for certain life-threatening conditions in the intensive care unit. It can be achieved by two modalities: membrane TPE (mTPE) filtering plasma from the blood components based on molecular size; while centrifugal TPE (cTPE) separating plasma from the whole blood by centrifugal force. Studies have shown cTPE tends to have a longer filter life and better efficiency, yet local data is lacking.
Objectives :
To compare the performance of filtration technique and centrifugation technique for TPE.
To assess which technique is the nurse’s preferred modality.
Methodology :
Firstly, we retrospectively reviewed data from January 2021 to June 2022. Data on hourly plasma volume removal, treatment duration, pre- and post-TPE laboratory results, and clotting events were recorded and analyzed. Mann-Whitney U test was used to compare the independent samples between filtration and centrifugation, while Wilcoxon signed-rank test was used to compare the related samples between pre- and post- value (Filtration; centrifugation).
Secondly, we interviewed the frontline nurses on their preferred technique to perform TPE.
Result & Outcome :
Fifty sessions of TPEs were performed during the study period. Twenty-nine used filtration and 21 used the centrifugation technique.
cTPE performance was significantly superior to mTPE, with an hourly plasma removal rate of 2194 vs 1176 ml/hr (p = < 0.001); shorter treatment duration (73 vs 120 mins, p = < 0.001) and absence of circuit or filter clotting events (0% vs 15%, p = < 0.001).
Anticoagulant Citrate Dextrose Solution A (ACDA) was used mainly in cTPE, while Low Molecular Weight Heparin (LMWH) was used solely in mTPE. Nevertheless, circuit or filter clotting occurred in 2 (40%) out of 5 sessions of mTPE with ACDA as the anticoagulant.
Due to the labor-intensive nature of TPE operation, cTPE encountered less troubleshoot and filter clots, therefore, it becomes ICU nurses’ favorite modality for TPE.
Conclusion:
Although both techniques of TPEs could achieve the therapeutic target safely and effectively, cTPE is associated with fewer circuit clotting events, higher plasma removal rate and shorter treatment duration when achieving the same treatment quality.
