Transcript UKPS Slide Show 2012 - The UK Photopheresis Society

2012
The UK
Photopheresis
Society
Friday 28th September
The Copthorne Tara Hotel
Kensington, London
Nursing Session
T Maher, Rotherham
J Murray, Manchester
GvHD and the assessment of
your patient
Cellex / XTS Issues
CELLEX V XTS
MAGGIE FOSTER
UNIT MANAGER
ROTHERHAM PHOTOPHERESIS
AIM OF PRESENTATION
Insight into Rotherham Service.
Advantages/Disadvantages of Cellex& XTS.
Discuss frequent occurring problems.
ROTHERHAM PHOTOPHERESIS UNIT
Rotherham General Hospital has been delivering this
specialised treatment 1994,and in 2009 the Rotherham
Photopheresis Unit achieved Foundation Trust Status,
The service at Rotherham is expanding rapidly and in
2009 with Paediatric medical support began to treat
children under the age of sixteen.
We Currently treat 70 patients 10 of these are
paediatrics.
THERAKOS MACHINES THROUGH THE
AGES
1987-1998
1998-present
2006-present
XTS
ADVANTAGES
 Quieter
DISADVANTAGES
 Takes longer to prime
 Longer treatment times
 More chances of Vaso
 Less stressful for the
operator
Vagal episodes.
 Single needle mode only
 Less alarms
 Not continuous flow
system
 Latex ports
CELLEX
ADVANTAGES
Quicker to prime only takes 7 minutes
Shorter treatment times (1-2-1/2
hours)
Discontinuous flow system (Single
Needle Mode)
Continuous flow system(Double
Needle Mode)
Patients with low body weights or low
Haemoglobins can be treated.
Less risk of vasovagal episodes.
Latex free ports(patients with Latex
allergy can be treated.
High white cell collection.
DISADVANTAGES
Very sensitive to touch or
tremors.
Numerous alarms
More nurses input
More impact on nurse/patient
time.
MOST FREQUENT
OCCURING PROBLEMS
XTS
 Disposable Failures
 System Pressures
CELLEX
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Red Cell Pump Alarms.
System Pressures.
Damaged kits(kinks in tubes).
Sensor Domes Failing.
Prime 10,
Treatment Bag Air Detected.
Collect/return Pressures.
Blocked Injection Ports.
V3 in double needle mode
(return rate not matching
Collect rate
 Retainer Clips springing open
during prime.
Red Cell Pump Alarm
(Plasma /Red Cell Interface Too Low)
Possible causes
High Lipids.
or
High Bilirubin
Present in the plasma
Problem Solving
Go to set up
Go to Bowl Optic
Threshold
Lower Value by 10
Resume Drawing
Lower collect rate to
25ml/min
.
Red Cell Pump alarm
(Plasma Red Cell Interface To High
Possible Causes
 Poor access resulting in
slow flow rates
 High Flow rates combined
with abnormal red cell
morphology.
 Occlusion of Red Cell
line due to trapped air,
Platelet clumps or
pinched line.
Problem Solving
 Whole blood Processed
(WBP) 500-1000mls
 Press Start, Pause,
Stop
 Continue to collect at
25mls/min
 May get a system
pressure alarm.
 WBP greater then
1000mls Proceed to
Buffy Coat Collection
Red Cell Streaming
Bowl over filling
SYSTEM PRESSURE ALARMS
 Usually Occurs after Establishing Separation and
start of Collect.
 Elutriation (Buffy Coat Stage)
May be due to : Trapped Air in Centrifuge Bowl during Purging air
stage
 Air Entering Centrifuge bowl After Purging Air stage,
 Platelet clumps.
 Increased viscosity of cells leaving the bowl during
Buffy Coat Collection.
PATIENTS PROBLEMS
XTS
No major problems to note.
CELLEX
 Metallic taste in mouth.
 Sparkly bits in eyes.
 Haematuria.
BLOCKED INJECTION PORT
BLOOD LEAK DUE TO A SPLIT DRIVE
TUBE
THANK YOU
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Dr Peter Taylor
Dr Arun Alfred
Tracy Maher
Cheryl Swift
Rachel Goodgrove
Janet Mayo
Julie
Ball
Freda Hammerton
Robert Whittle.
Helen Denney
Director of Rotherham Photopheresis
Haematology Consultant.
Unit Sister.
Unit Sister.
Unit Sister.
Health Care Assistant.
Research Nurse.
Data Collection Manager.
Research Scientist.
Research Assistant.
Contact Us
•
01709427003
•
www.photopheresis.co.uk
Coagulation issues
(Heparin ratios / platelets)