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Plasma exchange using peripheral arterial and venous access in the pediatric intensive care unit
Eytan Kaplan1,2, Avichai Weissbach1,2, Gili Kadmon1,2
1Pediatric Intensive Care Unit, Petah Tikva, Israel.
Insights
Arterial catheters (ALs) offer a safe and effective alternative for pediatric therapeutic plasma exchange (TPE) in the pediatric intensive care unit (PICU). This method may reduce sedation needs and vascular complications compared to traditional catheters.
Area of Science:
- Pediatric Intensive Care
- Vascular Access Devices
- Apheresis
Background:
- Therapeutic plasma exchange (TPE) is crucial in pediatric intensive care units (PICUs).
- Traditional TPE uses large-bore catheters, requiring deep sedation and risking complications.
- Percutaneous radial artery catheters (ALs) have shown promise in apheresis.
Purpose of the Study:
- To evaluate the safety and utility of ALs for TPE in pediatric patients.
- To compare AL use with traditional catheter methods for TPE in the PICU.
Main Methods:
- Retrospective cohort study of children (≤19 years) undergoing TPE with ALs (2018-2023).
- ALs used for inlet access, with peripheral IVs for blood return.
- Evaluated procedure utility and safety, noting AL size and location.
Main Results:
- 72 TPE procedures performed on 20 children using ALs.
- 94% procedure success rate; 6% had transient delays due to AL malfunction, resolved by replacement.
- ALs (20/22 gauge) in radial arteries showed no significant impact of gauge on flow or duration.
Conclusions:
- ALs are a viable alternative vascular access for pediatric TPE.
- Potential benefits include reduced sedation and lower vascular complication risk.
- Further research is recommended for routine PICU TPE practice.
Objective:
Therapeutic plasma exchange (TPE) is a vital therapeutic modality in pediatric intensive care units (PICU) for various indications. Traditionally, pediatric TPE is performed via a large bore, double lumen catheter, whose insertion necessitates deep sedation, and poses risk of hemorrhagic and thrombotic complications. Building on our previous success utilizing percutaneous radial artery catheters (ALs) for apheresis procedures, we present our experience with ALs for TPE procedures in the PICU.
Methods:
A retrospective cohort study, conducted in the PICU of a tertiary, university affiliated pediatric hospital, including all children aged 19 years and younger, who underwent TPE using an AL for vascular access, between 2018 and 2023. TPE procedures were evaluated for utility (the procedure was performed as planned) and safety.
Results:
A total of 72 procedures were performed on 20 children, using ALs for inlet access and peripheral intra-venous catheters for blood return. Procedure success rate was 94%, with AL malfunction causing transient delays in 6%. All were successfully completed following AL replacement. ALs were mostly 20 and 22 gauge, predominantly located in the radial artery. AL gauge did not significantly affect flow rate or procedure duration.
Conclusions:
Our findings support AL use for vascular access, as a viable alternative to the traditional large bore, double lumen catheters most often used for TPE in children. Benefits of AL use may include a decrease in sedation requirements and a lower risk of vascular complications. Further investigation is warranted, for consideration as routine practice in PICUs.
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