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Policies,Clinical,UWHC Clinical,Department Specific,Nursing Patient Care,Cardiovascular and Infusion

Photopheresis (Adult) (1.05A)

Photopheresis (Adult) (1.05A) - Policies, Clinical, UWHC Clinical, Department Specific, Nursing Patient Care, Cardiovascular and Infusion

1.05A

NURSING PATIENT CARE POLICY & PROCEDURE





Effective Date:
September 28, 2017

Administrative Manual
Nursing Manual (Red)
Other _______________

Policy #: 1.05A

Original
Revision
Page
1
of 4
Title: Photopheresis (Adult)

I. PURPOSE

To provide guidance for the Registered Nurse (RN) performing photopheresis.

II. POLICY

Photopheresis can be performed by a trained Infusion Center RN.

III. DEFINITION

A. The precise mechanism of action of photopheresis therapy is not entirely
understood; however, it is postulated that the methoxsalen increases the
sensitivity of the T-cells to ultraviolet radiation which, in turn, inactivates the
cells' replicating properties by binding DNA. Thus, when the irradiated cells are
re-infused into the body, these cells no longer retain their cytotoxic property,
which provides an active immunization effect.

IV. EQUIPMENT

A. UV protective lenses for the patient from UW pharmacy (must be obtained prior
to first treatment)
B. Cellex machine
C. Cellex procedural kit stored on unit
D. (1) 500 mL bag normal saline
E. (1) 500 mL bag of normal saline with 10,000 units heparin obtained from
pharmacy
F. Venipuncture supplies or hemodialysis catheter and/or venous access devices with
supplies —related policies:
1. Nursing Patient Care Policy 1.23 AP Continuous Peripheral Intravenous
Therapy (Adult & Pediatric)
2. Nursing Patient Care Policy 1.28AP, Care of Hemodialysis/Apheresis
Catheters (Adult & Pediatric)
3. Nursing Patient Care Policy 1.57 AP, Care of Vortex Vascular Access
Device when used for apheresis (Adult & Pediatric)
G. One (1) vial of methoxsalen 20 mcg/mL, a 3-5 ml syringe and a needle from
Central Services (CS)




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V. PROCEDURE

A. Review provider order for photopheresis procedure.
B. Verify patient consent from transfusion provider.
C. Obtain lab orders from provider: hematocrit, platelets and INR.
D. Follow standard and transmission-based precautions according to UW Health
Clinical Policy 4.1.8, Standard Precautions and Isolation.
E. Perform hand hygiene according to UW Health Clinical Policy 4.1.13, Hand
Hygiene.
F. Prior to instituting procedure, load and prime Cellex machine according to
manufacturer specifications.
G. Determine if this is to be a single or double needle procedure based on the
patient’s vascular access. Record this selection on the Cellex data entry screen.
H. Access vacular access device according to Policy 1.23AP Continuous Peripheral
Intravenous Therapy (Adult & Pediatric) or Policy 1.56 Central Vascular Access
Device Use, Maintenance and Removal (Adult & Pediatric).
I. Attach Cellex kit tubing to the venous access.
J. Press “Start”. Adjust the Access flow to 20 mL/min and Return flow to 5mL/min
during the initial 7 minute Air Purge Cycle.
K. Following Air purge Cycle, increase the inlet flow to 35mL/min and Return flow
to 40 mL/min for duration of Photopheresis procedure. If patient’s venous access
will not support this rate, lower the rate until no further access alarms are noted.
L. During the Collect Phase, of the procedure, monitor the patient for hypotension,
dizziness or lightheadedness every 30 minutes or more often if indicated based on
patient response to therapy.
M. Once the plane of the Bowl Optic Sensor has been crossed, monitor the level of
RBCs in the centrifuge bowl, the red cell return pump and the numeric value of
the Bowl Optic Sensor until 1500 mL of whole blood have been processed.
N. When the machine prompts “Collect Buffy”, open the HCT graph and monitor the
collection of the buffy coat into the treatment bag.
O. After the collected buffy coat has crossed HCT sensor, the Cellex will offer a
prompt to add the specified dose of Methoxsalen to the treatment bag. Confirm
the correct value of the Methoxsalen dose by multiplying the treatment volume by
0.017. Both numbers should be the same. Confirm accurate calculations and
Methoxsalen dose with a second RN as an independent double check.
P. Cleanse the access port on the treatment bag with an alcohol wipe for 15 seconds,
allow to dry then inject Methoxsalen and press the appropriate button to begin
photo activation. Charting the dose of methoxsalen in the patient’s MAR requires
confirmation and the signature of a second RN. The system automatically
calculates the duration of Photoactivation time based on the volume and
hematocrit of the collected white blood cells (WBCs).
Q. During the photactivation phase, the treatment volume is continuously circulated
through and across the banks of ultraviolet lights in the photoactivation chamber
and back into the treatment bag. This continuous circulation of the treated cells
ensures that all cells receive adequate exposure to the UVA light for an effective
photopheresis process.
R. At the completion of the photoactivation, the Cellex machine will reinfuse the
treated WBCs into the patient. Following reinfusion, the “Treatment Complete”
screen appears. At the machine prompt, clamp the patient’s vascular access lines

Page 3 of 4

and disconnect the patient from the Cellex machine. Remove the peripheral vein
access if appropriate or flush and lock venous access devices according to UWH
Flushing and Locking Guidelines.
S. Dispose of the contaminated instrument tubing, normal saline and heparin bags in
accordance with UW Health, Hazardous Material & Waste Management Plan.
T. Clean the outer parts of the Cellex machine as well as the centrifuge chamber
according to manufacturer’s recommendations.
U. Power off Cellex machine.
V. Document the following in the patient’s clinical record:
1. Extracorporeal blood volume treated
2. Amount of methoxsalen administered during treatment
3. Amount of anticoagulant infused
4. Amount of saline infused
5. Any occurrence of adverse reactions
6. Any other medications administered during treatment
W. Provide patient teaching regarding importance of wearing UV protective lenses
following both days of therapy to prevent formation of cataracts related to
increased sensitivity to ultraviolet light.
1. UV lenses are obtained from UW pharmacy and must be ordered prior to
initiation of first treatment. Protective lenses are placed on the patient one
(1) hour prior to completion of photopheresis.
2. For post-UV radiation phase, instruct the patient to wear UV protective
lenses at all times for 24 hours after each treatment.
X. Wipe down and clean Cellex Machine per manufacturer recommendations.

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 Patient Care Policy 1.57 AP, Vortex Venous Access Device when used
for Apheresis (Adult & Pediatric)
G. UWH Flushing and Locking Guidelines (U-Connect)

VII. REFERENCE

Cellex Operator’s Manual

VIII. REVIEWED BY

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



Page 4 of 4

SIGNED BY

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