TPE plasmapheresis access question.

[thomstew]

Has anyone ever done a plasmapheresis at the same time as a CRRT is running, using the same access catheter just putting 4 way stopcocks on each port -access and return lines? Another dialysis nurse told me this was being done in other parts of the country. Our protocol is to stop CRRT do the TPE then reset up the CRRT. It's not real cost effective. Please just for my sake I'd like to see any articles about the efficiancy of the tx and access flows or any experience some one has would be helpful. Thanks

[km5v6r, EdD, RN]

Another dialysis nurse told me this was being done in other parts of the country. Our protocol is to stop CRRT do the TPE then reset up the CRRT.

We also stop the CRRT for plasmaphoresis. Actually by that point that machine has usually clotted anyway and we just wait until after the TPE to resume the treatment. A couple of other issuses to bring up 1. I have never seen a 4 way stopcock. I work with 3 ways all the time but haven't seen a 4 way at work. 2. What machine do you use for CRRT? It could make a difference. We use the Fersenius which requires a separate r/o. It would be physically impossible to fit the R/O, dialysis machine and TPE machine into the same room with the pt, vent, IV pumps etc. The ICU nurse's and resp therapy already complain about climbing over machinery to get to the pt as it is. 3. How would the UFR be calculated while they are on TPE? The Red Cross does all of the TPE here and I am not totally familiar with it. I know it involves removing plasma and replacing it with large volumes of albumen but wouldn't that potentially cause hypovolemia or hypotension issuses to UF and plasma exchange at the same time? 4. How much more blood volume would be outside the body for the pt? Could the pt tolerate that additional loss even temporarily? If the dialysis filter clotted and the system was lost how would that affect the TPE treatment? Bottom line around here is that the pt's we do CRRT/SLED are to sick to tolerate much playing around. I tell families that dialysis is like doing metabolic areobics, CRRT is like a brisk walk. I would think TPE at the same time puts them back at the level of the metabolic areobics. If they can tolerate that then why not do conventional HD?

[thomstew]

As I said a girl I work with told me this. It makes no sense to me for all the reasons you stated. Plus there is no policy even on this. This isn't the only thing she's said that I really question the validity of... I just thought I would do some research of my own and even see if it was possible!! We use the PRISMA CRRT no RO needed so it's small but there never is enough room anyway. Thanks for the answer.. anyone else?

[km5v6r, EdD, RN]

This isn't the only thing she's said that I really question the validity of

Question and keep questioning. I have worked with nurses like this and it can become a very difficult situation. The ones I have worked with in the past were very charismatic and confident. To the less experienced they sounded like an expert. Some of the ideas sounded good, do able and cutting edge. Until someone else tried some independent investigation or applied critical thinking. Good luck with your continued investigation. It will be interesting to see what any one else has to say.