| Contenuto |
The success of therapeutic apheresis (TA), similar to hemodialysis, depends on the
integrity of the extracorporeal circuit as well as a reliable vascular access. However,
unlike hemodialysis, which requires high flow of blood around 400 mL⁄ minute through the
extracorporeal circuit for effective clearance, TA is usually carried out with
much lower blood flow rates (<100 ml ⁄ minute). Therefore, even peripheral
venous access can be considered for TA. The main determinants of the choice of
vascular access for TA is the duration of the planned treatment and, to a
certain degree, the indication for its use. While peripheral venous access and
temporary central venous catheters are sufficient for short-term TA, tunnelled
catheters and arteriovenous fistulae (AVF) are usually used for long-term treatments.
Because of the large body of evidence in the hemodialysis literature on the
advantages of AVF over tunnelled catheters and AV grafts, they should be
considered as the preferred access for chronic TA as well. However, advance
planning for the care of AVF after creation is of critical importance
especially since many of the healthcare providers dealing with TA are less
familiar with caring for AVF than nephrologists and dialysis nurses. In this
article we first review the similarities and differences between HD and TA
procedures. The pros and cons of different vascular access options are
discussed next. Finally, we have included a list of recommendations on maintenance
of AVF created for TA based on our own experience.
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