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2012 The UK Photopheresis Society

2012 The UK Photopheresis Society. Friday 28th September The Copthorne Tara Hotel Kensington, London. Nursing Session T Maher, Rotherham J Murray, Manchester. GvHD and the assessment of your patient . Cellex / XTS Issues. CELLEX V XTS. MAGGIE FOSTER UNIT MANAGER

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2012 The UK Photopheresis Society

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  1. 2012The UK PhotopheresisSociety Friday 28th September The Copthorne Tara Hotel Kensington, London

  2. Nursing Session T Maher, Rotherham J Murray, Manchester

  3. GvHD and the assessment of your patient

  4. Cellex / XTS Issues

  5. CELLEX V XTS MAGGIE FOSTER UNIT MANAGER ROTHERHAM PHOTOPHERESIS

  6. AIM OF PRESENTATION • Insight into Rotherham Service. • Advantages/Disadvantages of Cellex& XTS. • Discuss frequent occurring problems.

  7. ROTHERHAM PHOTOPHERESIS UNIT Rotherham General Hospital has been delivering this specialised treatment 1994,and in 2009 the Rotherham Photopheresis Unit achieved Foundation Trust Status, The service at Rotherham is expanding rapidly and in 2009 with Paediatric medical support began to treat children under the age of sixteen. WeCurrently treat 70 patients 10 of these are paediatrics.

  8. THERAKOS MACHINES THROUGH THE AGES 1987-1998 1998-present 2006-present

  9. XTS ADVANTAGES DISADVANTAGES Takes longer to prime Longer treatment times More chances of Vaso Vagal episodes. Single needle mode only Not continuous flow system Latex ports • Quieter • Less stressful for the operator • Less alarms

  10. CELLEX ADVANTAGES • Quicker to prime only takes 7 minutes • Shorter treatment times (1-2-1/2 hours) • Discontinuous flow system (Single Needle Mode) • Continuous flow system(Double Needle Mode) • Patients with low body weights or low Haemoglobins can be treated. • Less risk of vasovagal episodes. • Latex free ports(patients with Latex allergy can be treated. • High white cell collection. DISADVANTAGES • Very sensitive to touch or tremors. • Numerous alarms • More nurses input • More impact on nurse/patient time.

  11. MOST FREQUENT OCCURING PROBLEMS

  12. XTS CELLEX Red Cell Pump Alarms. System Pressures. Damaged kits(kinks in tubes). Sensor Domes Failing. Prime 10, Treatment Bag Air Detected. Collect/return Pressures. Blocked Injection Ports. V3 in double needle mode (return rate not matching Collect rate Retainer Clips springing open during prime. • Disposable Failures • System Pressures

  13. Red Cell Pump Alarm(Plasma /Red Cell Interface Too Low) Possible causes • High Lipids. or • High Bilirubin Present in the plasma Problem Solving • Go to set up • Go to Bowl Optic Threshold • Lower Value by 10 • Resume Drawing • Lower collect rate to 25ml/min .

  14. Red Cell Pump alarm(Plasma Red Cell Interface To High Possible Causes • Poor access resulting in slow flow rates • High Flow rates combined with abnormal red cell morphology. • Occlusion of Red Cell line due to trapped air, Platelet clumps or pinched line. Problem Solving • Whole blood Processed(WBP) 500-1000mls • Press Start, Pause, Stop • Continue to collect at 25mls/min • May get a system pressure alarm. • WBP greater then 1000mls Proceed to Buffy Coat Collection

  15. Red Cell Streaming Bowl over filling

  16. SYSTEM PRESSURE ALARMS • Usually Occurs after Establishing Separation and start of Collect. • Elutriation (Buffy Coat Stage) May be due to :- • Trapped Air in Centrifuge Bowl during Purging air stage • Air Entering Centrifuge bowl After Purging Air stage, • Platelet clumps. • Increased viscosity of cells leaving the bowl during Buffy Coat Collection.

  17. PATIENTS PROBLEMS XTS CELLEX Metallic taste in mouth. Sparkly bits in eyes. Haematuria. No major problems to note.

  18. BLOCKED INJECTION PORT

  19. BLOOD LEAK DUE TO A SPLIT DRIVE TUBE

  20. THANK YOU • Dr Peter Taylor Director of Rotherham Photopheresis • Dr Arun Alfred Haematology Consultant. • Tracy Maher Unit Sister. • Cheryl Swift Unit Sister. • Rachel Goodgrove Unit Sister. • Janet Mayo Health Care Assistant. • Julie Ball Research Nurse. • Freda Hammerton Data Collection Manager. • Robert Whittle. Research Scientist. • Helen Denney Research Assistant.

  21. Contact Us • 01709427003 • www.photopheresis.co.uk

  22. Coagulation issues (Heparin ratios / platelets)

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