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Therapeutic Leukopheresis (Adult) (1.02A)

Therapeutic Leukopheresis (Adult) (1.02A) - Policies, Clinical, UWHC Clinical, Department Specific, Nursing Patient Care, Cardiovascular and Infusion

1.02A

NURSING PATIENT CARE POLICY & PROCEDURE





Effective Date:
September 28, 2017

Administrative Manual
Nursing Manual (Red)
Other ______________

Policy #: 1.02A

Original
Revision

Page
1
of 3
Title: Therapeutic Leukopheresis (Adult)

I. PURPOSE

To provide guidance for performing therapeutic leukophoresis.

II. POLICY

Leukopheresis is performed by an Infusion Center Registered Nurse (RN) under the
direction of a Transfusion Medicine provider.

III. DEFINITION

A. Therapeutic leukopheresis is a procedure in which large volumes of abnormal
white cells are removed from the blood through the use of an automated
centrifugal blood cell separator.

IV. EQUIPMENT AND SUPPLIES

A. Spectra Optia Apheresis system
B. Spectra Optia IDL kit
C. IDL filter
D. IV solutions
1. 0.9% sodium chloride – 1,000 mL
2. Anticoagulant ACD-A – 1,000 mL
E. If using peripheral vein access : refer to Nursing Patient Care Policy 1.23AP,
Continuous Peripheral Intravenous Therapy (Adult & Pediatric):
1. Needles for return and access sites of sufficient gauge to support
procedure flow rate
2. Supplies for preparing venipuncture sites.
F. If using a central vascular access device or hemodialysis catheter, refer to Nursing
and Patient Care Policy 1.56 AP, Central Vascular Access Device Use,
Maintenance and Removal (Adult & Pediatric) or Nursing Patient Care Policy
1.28AP, Care of Hemodialysis/Apheresis Catheters (Adult & Pediatric):
1. Supplies to disinfect, aspirate, and connect the device.
G. Blood warmer and blood warmer tubing set

V. PROCEDURE

A. Review order from provider.
B. Verify patient consent from Transfusion Medicine Physician.

Page 2 of 3

C. Review order for lab work from authorized provider to be collected prior to
procedure.
D. Select “CMNC” procedure on the procedure selection screen. Confirm the IDL
filler has been installed on the centrifuge.
E. Confirm the correct IDL tubing set; check expiration date and lot number.
F. Select “Prepare Tubing Set” on the Optia screen.
G. Load the IDL set according to Spectra Optia Apheresis System Operator’s
Manual, Chapter 5 Preparing to Perform Procedure.
H. Enter and confirm patient and procedure data. The Spectra Optia system uses sex,
height and weight to calculate the patient’s total blood volume. If the provider
designates a different value, touch the TBV and enter a different value.
I. Enter data necessary (listed below) to customize the IDL collection procedure to
white blood cell depletion collection. This is per Terumo Optia’s operation
manual for procedure.
1. Ensure the packing factor is 4/5
2. Inlet AC ratio is 12:1
3. Collect pump flow rate will be determined by the calculation of inlet flow
rate x (1-[1/12]) x (WBC count x (0.0007). (Example: Inlet flow rate is 60
x (1-[1/12]) x (WBC count) x (0.0007). The resulting collect flow rate on
the Spectra Optia CMNC protocol is 10 mL/min. In the example
calculation, the collect pump flow rate of 15/4 would be changed to 10.
J. Establish access and begin the procedure.
K. Obtain baseline vital signs and record on the apheresis flow sheet. Monitor vital
signs every 15 to 30 minutes during the procedure.
L. Monitor the procedure. Touch the Collection Status tab to monitor the progress of
the run and to adjust the collection preference. The collection preference is a
reference number that the system uses to adjust the plasma pump flow rate, which
affects the concentration of cells that flow through the collect port. Use the up and
down arrows to change the collection preference during the procedure to achieve
the desired outcome. The default collection preference is 50. Using the Collection
Preference Tool located on the front of the machine, aim for a color most
matching the central color on the graph. This will avoid depleting too many red
blood cells and will achieve a collection with an approximate hematocrit of 3-5
percent.
M. Observe the patient for complications of hypotension, citrate toxicity and
hematoma at the venipuncture sites.
N. Document the following in the patient’s clinical record:
1. Type of therapeutic procedure performed
2. Type of vascular access
3. Extracorporeal blood volume
4. Volume and type of replacement fluids
5. Adverse reactions and medications administered to mitigate
O. Practice universal precautions as outlined in UW Health Clinical Policy 4.1.8,
Standard Precautions and Isolation.
P. Dispose of biohazardous waste at completion of procedure according to UW
Health Hazardous Material & Waste Management Plan.




Page 3 of 3

VI. UW HEALTH CROSS REFERENCES

A. UW Health Hazardous Material & Waste Management Plan (U-Connect)
B. UW Health Clinical Policy 4.1.8, Standard Precautions and Isolation
C. UW Health Clinical Policy 4.1.13, Hand Hygiene
D. Nursing Patient Care Policy 1.23AP, Continuous Peripheral Intravenous Therapy
(Adult & Pediatric)
E. Nursing Patient Care Policy 1.28AP, Care of Hemodialysis/Apheresis Catheters
(Adult & Pediatric)
F. Nursing and Patient Care Policy 1.56 AP, Central Vascular Access Device Use,
Maintenance and Removal (Adult & Pediatric)

VII. REFERENCE

A. Spectra Optia Apheresis System – Operator’s Manual

VIII. REVIEWED BY

Nurse Manager, Infusion Center
Nurse Clinician, Transfusion/Infusion Center
Nursing Patient Care Policy and Procedure Committee, September 2017

SIGNED BY

Beth Houlahan, DNP, RN, CENP
Senior Vice President, Chief Nurse Executive