NURSING PATIENT CARE POLICY & PROCEDURE
November 24, 2017
Nursing Manual (Red)
Policy #: 1.01AP
Title: Therapeutic Plasma Exchange (Adult &
To provide guidance for the registered nurse (RN) performing Therapeutic Plasma
Therapeutic Plasma Exchange may be performed by the trained/competent Infusion
Center nurse who has received education for managing the process, equipment, and
patient care necessary for this procedure.
III. EQUIPMENT AND SUPPLIES
A. Terumo Optia Pheresis Instrument
B. Blood warming tubing and extension set
C. Therapeutic Plasma Exchange Set - Special Order –Spectra Optia Aphersis
D. Exchange filler
E. IV solutions
1. 0.9% sodium chloride – 1,000 ml or 500ml normal saline
2. Anticoagulant ACD-A – 500-1000 mL
F. Replacement fluids as ordered by provider
G. Venipuncture/vascular access device supplies
H. Medications as ordered by provider
1. To treat known reactors to plasma
a. Acetaminophen - antipyretic
b. Diphenhydramine hydrochloride - antihistamine
c. Dexamethasone steroid
2. Citrate toxicity (sensitivity to ACD-A)
a. TUMS (for the calcium content)
b. Calcium gluconate IV
I. Standard Consent Form
A. Obtain order from provider.
B. Verify patient consent from transfusion provider.
C. Obtain order for lab work from authorized provider:
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3. Calcium level
4. Serum viscosity, total protein and IgM level in patients with suspected
5. Type and screen if plasma is used (if one is not on file in the Blood Bank
D. Schedule patient’s procedure time with patient (if outpatient) or with the inpatient
nursing unit. Collaborate with the bedside nurse regarding the care plan.
E. Set up Terumo instrument with TPE set according to the Terumo Manual.
F. Obtain replacement fluids.
1. Albumin 5% - obtain from acudose
2. Plasma from Blood Bank
G. Receive patient in apheresis treatment room (C5/350) or, if necessary, transport
equipment to patient bedside.
H. Perform hand hygiene according to UW Health Policy 4.1.13, Hand Hygiene.
Practice universal precautions as outlined in UW Health Clinical Policy 4.1.8,
Standard Precautions and Isolation.
I. Obtain and record baseline vital signs on Therapeutic Apheresis flowsheet and
monitor every 15-30 minutes during procedure. Record vital signs and procedure data
on Therapeutic Apheresis flowsheet.
J. Verify vascular access and administer premedication for venipuncture, if indicated
(refer to Nursing Patient Care Policies, 1.23AP, and 1.28AP, 1.56AP). Confer with
care team regarding the use of central vascular access device.
K. Connect access and return lines.
L. Perform procedure per manufacturer’s instructions. (Refer to the Terumo Manual.)
M. Observe patient for complications.
a. Slow or stop procedure
b. Place bed in flat position
c. Administer extra IV fluid according to provider order
d. If blood pressure does not respond, abort procedure and notify
2. Citrate toxicity
a. Slow procedure; administer TUMS
b. Administer calcium according to provider order
3. Hematoma at venipuncture site.
a. Discontinue IV and restart at another site
4. Transfusion reaction (when plasma is used)
a. Pause transfusion and notify provider.
b. Refer to UW Health Clinical Policy 2.2.6, Blood and Blood
Component Transfusion (Requiring Pre-Transfusion Testing) for blood
product administration and treatment of possible transfusion reaction.
N. Document the following in the patient's clinical record:
1. Type of therapeutic procedure performed
2. Method used
3. Nature and volume of replacement fluids
4. Any occurrence of adverse reactions
5. Medication administered.
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O. Dispose of biohazardous waste at completion of procedure according to UW Health
Hazardous Material & Waste Management Plan.
V. UW HEALTH CROSS REFERENCES
A. UW Health Hazardous Material & Waste Management Plan
B. UW Health Clinical Policy 2.2.6, Blood and Blood Component Transfusion
(Requiring Pre-Transfusion Testing)
C. UW Health Clinical Policy 4.1.8, Standard Precautions and Isolation
D. UW Health Clinical Policy 4.1.13, Hand Hygiene
E. Nursing Patient Care Policy 1.23AP, Continuous Peripheral Intravenous Therapy
(Adult & Pediatric)
F. Nursing Patient Care Policy 1.28AP, Care of Hemodialysis/Apheresis Catheters
(Adult & Pediatric)
G. Nursing and Patient Care Policy 1.56AP, Central Vascular Access Device Use,
Maintenance and Removal (Adult & Pediatric)
H. Nursing Patient Care Policy 1.57AP, Care of Vortex Vascular Access Device when
Used for Apheresis (Adult & Pediatric)
Terumo Optia- Essentials Guide & TPE Procedure Guide
VII. REVIEWED BY
Nurse Clinician, Infusion Center
Nurse Manager, Infusion Center
Nursing Patient Care Policy and Procedure Committee, November 2017
Beth Houlahan, DNP, RN, CENP
Senior Vice President, Chief Nurse Executive