Feasibility and Safety of Implementing Membrane-based Plasma Exchange in a Low-volume Center: Retrospective Single Center Experience Over 3 Years Including Multidisciplinary Survey among Clinicians
Xiao Jiang, Amit Kansal, Monika G Kansal, Faheem A Khan, Chee Keat Tan, Patricia Leong, Marjoyna Ortal, Rajat Tagore, Prashanth Ramesh, Shekhar Dhanvijay
Keywords :
Feasibility, Intensive care unit, Membrane-based, Plasma exchange, Safety
Citation Information :
Jiang X, Kansal A, Kansal MG, Khan FA, Tan CK, Leong P, Ortal M, Tagore R, Ramesh P, Dhanvijay S. Feasibility and Safety of Implementing Membrane-based Plasma Exchange in a Low-volume Center: Retrospective Single Center Experience Over 3 Years Including Multidisciplinary Survey among Clinicians. 2023; 2 (2):54-60.
Background: Membranous therapeutic plasma exchange (mTPE) is less commonly used in Singapore compared to centrifuge TPE. Our study aimed to investigate the feasibility and safety of mTPE as a new service in a low-volume TPE center that was familiar and experienced with the continuous renal replacement therapy (CRRT) technique.
Materials and methods: This was a single-center retrospective study of patients who underwent mTPE from 1st May 2018 to 31st July 2021, conducted at a 34-bedded mixed intensive care unit (ICU) in Singapore. Clinical data and mTPE details, including adverse events, were collected for all sessions. Multidisciplinary surveys of specialists and nurses involved were conducted thereafter in August 2021.
Results: During the study period, a total of 53 mTPE sessions were done for 10 patients, of which eight (80%) were female. Of a total of 53 sessions, filter clotting despite anticoagulation occurred in seven (13%) sessions. The adverse event rate was 11.3% of all sessions. A survey of five specialists and 12 ICU nurses indicated a smooth referral process, a short setup time, and easy hands-on in implementing mTPE as a new service in the ICU.
Conclusion: Our results show the feasibility and safety of introducing mTPE as a new service in ICU settings in a low-volume TPE center, with the specific logistical advantage of short training time in view of familiarity and experience with the CRRT technique. This also provided the ability to continue uninterrupted service during the pandemic and maybe a future direction for similar ICUs.
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