Apheresis: Access

• For patients already on extracorporeal therapies such as CKRT or ECMO, consider running apheresis in tandem with these procedures (i.e., accessing the existing circuits)

• For patients with a hemodialysis catheter, the HD catheter should be suitable to tolerate the flows required for the apheresis procedure

• Otherwise, a dedicated catheter will likely be required if peripheral venous access is not a viable option

Peripheral venous access (PVA)

• PVA could be considered for clinically stable patients who do not already have a central line

  • Not commonly used in North America, where central venous catheters are predominantly used, but is more common in Europe

  • If multiple procedures are anticipated, central access may be preferable

• Two peripheral lines are necessary

  • Unless doing a discontinuous centrifugation technique, in which a single catheter can be used

• Smaller lines pose higher risk for suboptimal flows, which can limit efficiency, extend treatment times, and potentially result in premature termination of the procedure

• Centrifugal method allows for lower blood flows (some as low as 10 mL/min), which peripheral cannulas may accommodate:

  • Typically 19- to 22-gauge IVs are used in pediatrics

    • 19- to 20-gauge IV can usually provide 60 mL/min of flow, while a 22-gauge IV typically provides ~36 mL/min of flow

      • Varies by manufacturer and vein characteristics

• Plastic intravenous catheters are often suitable, but a dialysis type steel needle may be used for the inlet access

• 7 Fr minimum (standard of care) for use with the apheresis machine due to the high flow rate, which will collapse the lumens of smaller catheters

  • Cannot use arterial line + peripheral IV combination

  • Cannot use multiple smaller lumen PICCs

• 9.5 Fr is sufficient to achieve flows needed for pheresis, i.e., no benefit to using larger-diameter catheter

• For short term/temporary access, prefer:

  • Internal jugular (IJ)

  • Non-tunneled (uncuffed)

• 7.5 Fr HD catheter not yet planned for use in pheresis at our institution