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 ablood 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 atechnique 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
asavery 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
• FFPor 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 asordered 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 acentral venous line ascentral 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 acentral
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 adraw 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 asfollows:
. 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 assesswhether the patient has become
severely hyperfibrinogenemic

18. COMPLICATIONS
• Immunosuppression
• Hypocalcemia
• Hypomagnesemia
• Hypothermia
Hypotension
• hyperfibrinogenemia
• Hematoma
Transfusion reaction

19. DOCUMENTATION

20. 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.