Transfusion and Apheresis Science 52 (2015) 137–140
Contents lists available at ScienceDirect
Transfusion and Apheresis Science j o u r n a l h o m e p a g e : w w w. e l s e v i e r. c o m / l o c a t e / t r a n s c i
Editorial
Apheresis nursing: A Canadian perspective
Introduction Nursing is a dynamic profession that continuously evolves with the rapid advance of new health care technologies. A good example of that is apheresis nursing, which is a relatively new area of nursing practice. Apheresis nurses are responsible for performing various apheresis procedures that may include, but are not limited to, plasma exchanges, red cell exchanges, platelet and white cell reductions, extracorporeal photopheresis and hematopoietic progenitor cell collections. Therapeutic apheresis is a field that emerged as a result of the growing use in various clinical applications of different modalities of blood component exchanges and modifications, including blood cell depletion and collections [1]. Today, therapeutic apheresis is an indispensable part of Canadian healthcare. It provides essential and often lifesaving apheresis procedures to large groups of hematologic, neurologic, renal, metabolic, organ transplant and autoimmune/ rheumatologic patients [2].
A brief history of apheresis Early therapeutic apheresis was limited to plasmapheresis (or exactly plasma exchange) modality only. Although the first experimental plasma exchange was performed on dogs by John J. Abel’s group at Johns Hopkins Medical School back in 1914 [3], the first successful therapeutic application of plasma exchange (TPE) in patients with macroglobulinemia was reported only in the late 1950s [4,5]. The early TPE procedures were an exhausting and slow manual process. Patient’s blood was collected in one bag (or bottle) at a time, spun in a centrifuge then plasma was decanted, packed cells re-suspend in saline or other replacement solutions and immediately re-infused, after which the process was repeated until the targeted plasma volume was exchanged [6]. In time, the manual technique was gradually replaced by more efficient and safe apheresis devices. The first prototype of the modern apheresis devices, developed by Dr. Edwin Cohn in Boston in the early 1950s [7], did not prove http://dx.doi.org/10.1016/j.transci.2014.12.011 1473-0502/© 2014 Published by Elsevier Ltd.
to be practical for therapeutic applications. Yet further advances in apheresis technology during the late 1960s and early 1970s led to the development of more practical and versatile centrifugal blood separators with intermittent or continuous flow capable of performing plasmapheresis as well as various cytapheresis procedures [1,8,9]. Initially, apheresis technology was used mainly in blood banking for collection of blood components (i.e. plasma, platelets and white cells) for transfusion purposes. But growing interest in the therapeutic application of apheresis during the 1970s–1980s led to the rapid expansion of this technology into the clinical field [10–20]. Some of the first apheresis programs originally evolved in conjunction with blood banks. Other programs were integrated within existing hospital units (i.e. hemodialysis, chemotherapy, and hematology). The first distinct apheresis units/clinics were opened in the early 1980s. Following the first successes in peripheral blood stem cell (PBSC) transplants [21–23], PBSC harvesting by apheresis for autologous and allogeneic transplantations was increasingly being used in Canada starting in the 1990s. More apheresis modalities, like photopheresis, plasma immunoadsorption, and LDL-apheresis, were implemented in some centers over the last 10 years. In 1979, the Canadian Apheresis Group (CAG) was established – the first Canadian professional organization with a focus on therapeutic apheresis. From its foundation, the CAG focused on collecting data on all apheresis procedures performed, monitoring the effectiveness of the treatments and surveying complications associated with it. In 1992, the Canadian Association of Apheresis Nurses affiliated with CAG was established, with the main goal of helping apheresis nurses from different parts of the country to share best practices, remain current and connected. The increasing use of apheresis for clinical applications is reflected by the growing number of apheresis facilities across Canada over the last decades.
Current status According to the Canadian Apheresis Group, there are 36 apheresis clinics/units in 22 cities across Canada (except one
138
E. Cojocari/Transfusion and Apheresis Science 52 (2015) 137–140
Table 1 Types of Procedures Performed in Apheresis Centers. Type of apheresis performed Plasmapheresis
Cytapheresis
Number of centers Therapeutic plasma exchange (TPE) Selective plasma adsorption Erythrocytapheresis Plateletpheresis Leukapheresis
province and 3 territories). Most centers are located in Québec – 14 and Ontario – 9, while the 3 cities with the largest number of apheresis centers are Montreal – 7, Toronto – 3 and Vancouver – 3. Practically all apheresis clinic units are located in acute care hospitals/centers and are set to provide various apheresis procedures to inpatient as well as outpatient settings. At least 6 apheresis operations are integrated with hemodialysis clinics. Apheresis treatments/ collections are normally provided during the week days (mostly on 8 hour shift). Up to 24 facilities also provide partial or 24/7 on-call services for emergent TPE or RBC depletion/exchanges. The range of types of apheresis procedures can vary from one center to another. Currently, some apheresis units can provide up to 8 different types of therapeutic/collection apheresis. As presented in Table 1, all apheresis centers/clinics except two, perform TPE procedures followed by – in decreasing order: leukapheresis, erythrocytapheresis, plateletpheresis and selective plasma absorption procedures. Depending on the types of the procedures provided, the apheresis centers can be equipped with up to three different type of apheresis devices. In terms of equipment technology, centrifugal blood separators with continuous flow are the mainstay of therapeutic apheresis in Canada. Membrane-type plasma separation is currently used only in devices for low-density lipoprotein apheresis. The apheresis programs are directed by physicians qualified by training and/or experience (often hematologists), and staffed by registered nurses with special training in apheresis. Currently, there are around 227 registered nurses engaged in clinical apheresis operations across Canada, 47% of which are full-time apheresis nurses.
Current issues As in any other nursing practice area, apheresis nurses are facing different challenges related to their practice. Probably the most evident challenges that can be identified in apheresis are nursing training and staffing. These issues are mostly determined by the highly specialized and technical nature of apheresis nursing. Apheresis is a field very much dependent on technology and employs complex automated devices. Use of complex medical devices can lead to adverse events caused by various factors [24,25]. According to the Food and Drug Administration (FDA), up to 9% of medical
Low density lipoprotein-apheresis ABO-specific Immunoadsorption RBC depletion/exchange Platelet depletion PBSC collection Donor lymphocyte collection Leukocyte depletion Bone marrow processing Extracorporeal photopheresis (ECP)
34 2 1 19 8 23 4 25 12 8
device failures are directly related to human errors [26]. A number of studies showed that between 10 and 19% of nurses had used medical devices improperly, and had consequently harmed the patients [27–29]. A study by Kiekkas et al. [30] identified that on the one hand, the increased risk of adverse events associated with use of complex equipment was caused by increased stress, human errors or mechanical faults; on the other hand, the increased stress and human errors was linked to inadequate training. Fouladinejad and Roberts [28] also showed that formal and regular training programs in the use of equipment are important to ensure safe and cost-effective utilization. Some studies also showed that use of complex medical devices causes more than 75% of staff nurses to feel stressed [29]. In this context, it is important to highlight the crucial role of appropriate training and safe nurse staffing in apheresis settings.
Training aspects The apheresis nurses training is built on a core body of nursing knowledge. Advanced training in apheresis is normally focused on principles of apheresis technology, different types of apheresis procedures, operation and troubleshooting of various apheresis systems, specific circulatory access techniques, management of adverse events associated with apheresis, related organizational policies and standard operating procedures. Currently, no academic institution or professional association provides accredited continuing education courses or a certification process for apheresis nurses. Typically, apheresis nurse training consists of orientation provided by the apheresis facility according to the organization’s educational program and SOPs and also training provided by the manufacturers of the apheresis devices. As many centers may perform up to 8 different types of apheresis procedures on different devices, it is often a challenge to maintain the full range of competences, especially when some procedures are rarely done. In cases when an apheresis program is integrated with other programs (i.e. hemodialysis), apheresis nurses are also required to have additional cross-training in the respective field. The development and implementation of standardized, structured educational programs in apheresis and objective evaluation of proficiency can further increase the safety and efficiency of apheresis procedures.
E. Cojocari/Transfusion and Apheresis Science 52 (2015) 137–140
Staffing aspects A growing body of knowledge shows that nursing staffing may significantly impact patient safety and the outcome of patient care as well as the nurse’s satisfaction [31]. Scheduling and staffing in therapeutic apheresis can often be particularly challenging and multifaceted due to the variety of apheresis procedures and apheresis devices employed. Some other factors that may contribute to complexity of the staffing process are:
• • • • • •
Variability in apheresis nurses training. Variability in the patient/donor’s clinical conditions Requirement to provide coverage and perform emergency procedures (i.e. TPE or RBCX) often performed on short notice and after hours. Difficulties to manage temporary staff shortages due to a usually limited pool of trained apheresis nurses. Difficulties in estimating the length and the outcome of some treatments/collections. Procedures performed out of the unit (i.e. inpatient units, operating rooms, other hospitals).
Although nursing staffing approaches may often vary in different apheresis facilities, there is a growing consensus in our professional group that in order to ensure safe and adequate nursing staffing in apheresis settings, the process should be standardized and consistent. Conclusion As therapeutic apheresis has made considerable progresses in the last decades, apheresis nursing has evolved into a distinctive practice area. Today, Canadian apheresis nursing is a relatively small, but growing professional group of practicing nurses with highly specific training. While apheresis continues to evolve and expand its applications, apheresis nurses as a professional group are in a unique position to identify and meet the challenges and opportunities associated with developing and maintaining high standards of care in this area. Acknowledgements Dr. David Barth, University Health Network, Toronto. Dr. Gail Rock, Canadian Apheresis Group, Ottawa. Dr. Hans Messner, University Health Network, Toronto. Jean O’Brien Louis, Canadian Apheresis Group, Ottawa. Karen Witiuk, University Health Network, Toronto. Pamela Harmon, University Health Network, Toronto. Susan Clarke, University Health Network, Toronto. Appendix: Supplementary material Supplementary data to this article can be found online at doi:10.1016/j.transci.2014.12.011. References [1] McLeod BC. Therapeutic apheresis: history, clinical application, and lingering uncertainties. Transfusion 2010;50:1413–26.
139
[2] Schwartz J, Winters JL, Padmanabhan A, Balogun RA, Delaney M, Linenberger ML, et al. Guidelines on the use of therapeutic apheresis in clinical practice – evidence-based approach from the Writing Committee of the American Society for Apheresis: the sixth special issue. J Clin Apher 2013;28:145–284. [3] Abel JJ, Rowntree LG, Turner BB. Plasma removal with return of corpuscles (plasmapheresis). J Pharmacol Exp Ther 1914;5:625– 41. [4] William AR. Late report of the first case of plasmapheresis for Waldenström’s Macroglobulinemia. JAMA 1981;245(6):606–7. [5] Solomon A, Fahey JL. Plasmapheresis therapy in macroglobulinemia. Ann Intern Med 1963;58:789–800. [6] Adams WS, Bland WH, Bassett SH. A method of human plasmapheresis. Proc Soc Exp Biol Med 1952;80:377–9. [7] Tullis JL. Principles involved in glycerolization and deglycerolization of red cells using the Cohn fractionator. In: Proceedings of a conference on plasma proteins and cellular elements of the blood, November 15, 1954. Cambridge (MA): Protein Foundation, Inc. and the Commission on Plasma Fractionation and Related Processes; 1954. p. 17–8. [8] Judson G, Jones A, Kellogg R, Buckner D, Eisel R, Perry S, et al. Closed continuous-flow centrifuge. Nature 1968;217:816–8. [9] Tullis JL, Tinch RJ, Baudanza P, Gibson JG 2nd, DiForte S, Conneely G, et al. Plateletpheresis in a disposable system. Transfusion 1971;11:368–77. [10] Bukowski RM, King JW, Hewlett JS. Plasmapheresis in the treatment of thrombotic thrombocytopenic purpura. Blood 1977;50:413–7. [11] Taft EG. Thrombotic thrombocytopenic purpura and the dose of plasma exchange. Blood 1979;54:842–9. [12] Okuno T, Kosova L. Plasmapheresis for thrombotic thrombocytopenic purpura. Transfusion 1979;19:342–4. [13] Cardella CJ, Sutton D, Uldall PR, de Veber GA. Intensive plasma exchange and renal transplant rejection. Lancet 1977;1:264. [14] Cardella CJ, Sutton DM, Falk JA, Katz A, Uldall PR, deVeber GA. Effect of intense plasma exchange on renal transplant rejection and serum cytotoxic antibody. Transplant Proc 1978;10:617–9. [15] Rifle G, Chalopin JM, Ture JM, Guigner F, Vialtel P, Dechelette E, et al. Plasmapheresis in the treatment of renal allograft rejections. Transplant Proc 1979;11:20–6. [16] Clarke CA, Elson CJ, Bradley J, Donohoe WTA, Lehane D, Hughes-Jones NC. Intensive plasmapheresis as a therapeutic measure in Rhesusimmunised women. Lancet 1970;295(7651):793–8. [17] Graham-Pole J, Barr W, Willoughby ML. Continuous-flow plasmapheresis in management of severe rhesus disease. Br Med J 1977;1(6070):1185–8. [18] Jones JV, Cumming RH, Bacon PA, Evers J, Fraser ID, Bothamley J, et al. Evidence for a therapeutic effect of plasmapheresis in patients with systemic lupus erythematosus. Q J Med 1979;48:555–76. [19] Jones JV, Cumming RH, Bucknall RC, Asplin CM. Plasmapheresis in the management of acute systemic lupus erythematosus? Lancet 1976;1:709–11. [20] Vallejos CS, McCredie KB, Brittin GM, Freireich EJ. Biological effects of repeated leukapheresis of patients with chronic myelogenous leukemia. Blood 1973;42:925–33. [21] McCredie KB, Hersh EM, Freireich EJ. Cells capable of colony formation in the peripheral blood of man. Science 1971;171:293–4. [22] Körbling M, Burke P, Braine H, Elfenbein G, Santos G, Kaizer H. Successful engraftment of blood derived normal hemopoietic stem cells in chronic myelogenous leukemia. Exp Hematol 1981;9:684– 90. [23] Goldman JM, Johnson SA, Catovsky D, Wareham NJ, Galton DA. Autografting for chronic granulocytic leukemia. N Engl J Med 1981;305:700. [24] Amoore J, Ingram P. Learning from adverse incidents involving medical devices. Nurs Stand 2003;17(29):41–6. [25] Grant L. Medical equipment. Devices and desires. Health Serv J 1998;108(5603):34–5. [26] Stephenson GM, Freiherr G. User training and human factors design: solutions for device failures. Med Device Diagn Ind 1990;12(9):50–3, 88. [27] Douglas MR, Leigh JA, Douglas CH. UK registered nurse medical device education: a comparison of hospital and bank nurses. Nurse Educ Pract 2001;1(2):85. [28] Fouladinejad F, Roberts JR. An analysis of training activities in the use of critical care equipment within hospitals in the United Kingdom. Anaesthesia 1998;53:810–22. [29] McConnel EA, Fletcher J. Agency registered nurse use of medical equipment: an Australian perspective. Int J Nurs Stud 1995;32(2):149–61.
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[30] Kiekkas P, et al. Use of technological equipment in critical care units: nurses’ perceptions in Greece. J Clin Nurs 2006;15(2):178– 87. [31] Aiken LH, Clarke SP, Sloane DM, Sochalski J, Silber JH. Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. JAMA 2002;288(16):1987–93.
Eduard Cojocari Listening Post Editor and Apheresis Nurse, University Health Network, Toronto, Ontario, Canada Tel.: (1) 647-995-6911 E-mail address: [email protected]
Contents lists available at ScienceDirect
Transfusion and Apheresis Science j o u r n a l h o m e p a g e : w w w. e l s e v i e r. c o m / l o c a t e / t r a n s c i
Editorial
Apheresis nursing: A Canadian perspective
Introduction Nursing is a dynamic profession that continuously evolves with the rapid advance of new health care technologies. A good example of that is apheresis nursing, which is a relatively new area of nursing practice. Apheresis nurses are responsible for performing various apheresis procedures that may include, but are not limited to, plasma exchanges, red cell exchanges, platelet and white cell reductions, extracorporeal photopheresis and hematopoietic progenitor cell collections. Therapeutic apheresis is a field that emerged as a result of the growing use in various clinical applications of different modalities of blood component exchanges and modifications, including blood cell depletion and collections [1]. Today, therapeutic apheresis is an indispensable part of Canadian healthcare. It provides essential and often lifesaving apheresis procedures to large groups of hematologic, neurologic, renal, metabolic, organ transplant and autoimmune/ rheumatologic patients [2].
A brief history of apheresis Early therapeutic apheresis was limited to plasmapheresis (or exactly plasma exchange) modality only. Although the first experimental plasma exchange was performed on dogs by John J. Abel’s group at Johns Hopkins Medical School back in 1914 [3], the first successful therapeutic application of plasma exchange (TPE) in patients with macroglobulinemia was reported only in the late 1950s [4,5]. The early TPE procedures were an exhausting and slow manual process. Patient’s blood was collected in one bag (or bottle) at a time, spun in a centrifuge then plasma was decanted, packed cells re-suspend in saline or other replacement solutions and immediately re-infused, after which the process was repeated until the targeted plasma volume was exchanged [6]. In time, the manual technique was gradually replaced by more efficient and safe apheresis devices. The first prototype of the modern apheresis devices, developed by Dr. Edwin Cohn in Boston in the early 1950s [7], did not prove http://dx.doi.org/10.1016/j.transci.2014.12.011 1473-0502/© 2014 Published by Elsevier Ltd.
to be practical for therapeutic applications. Yet further advances in apheresis technology during the late 1960s and early 1970s led to the development of more practical and versatile centrifugal blood separators with intermittent or continuous flow capable of performing plasmapheresis as well as various cytapheresis procedures [1,8,9]. Initially, apheresis technology was used mainly in blood banking for collection of blood components (i.e. plasma, platelets and white cells) for transfusion purposes. But growing interest in the therapeutic application of apheresis during the 1970s–1980s led to the rapid expansion of this technology into the clinical field [10–20]. Some of the first apheresis programs originally evolved in conjunction with blood banks. Other programs were integrated within existing hospital units (i.e. hemodialysis, chemotherapy, and hematology). The first distinct apheresis units/clinics were opened in the early 1980s. Following the first successes in peripheral blood stem cell (PBSC) transplants [21–23], PBSC harvesting by apheresis for autologous and allogeneic transplantations was increasingly being used in Canada starting in the 1990s. More apheresis modalities, like photopheresis, plasma immunoadsorption, and LDL-apheresis, were implemented in some centers over the last 10 years. In 1979, the Canadian Apheresis Group (CAG) was established – the first Canadian professional organization with a focus on therapeutic apheresis. From its foundation, the CAG focused on collecting data on all apheresis procedures performed, monitoring the effectiveness of the treatments and surveying complications associated with it. In 1992, the Canadian Association of Apheresis Nurses affiliated with CAG was established, with the main goal of helping apheresis nurses from different parts of the country to share best practices, remain current and connected. The increasing use of apheresis for clinical applications is reflected by the growing number of apheresis facilities across Canada over the last decades.
Current status According to the Canadian Apheresis Group, there are 36 apheresis clinics/units in 22 cities across Canada (except one
138
E. Cojocari/Transfusion and Apheresis Science 52 (2015) 137–140
Table 1 Types of Procedures Performed in Apheresis Centers. Type of apheresis performed Plasmapheresis
Cytapheresis
Number of centers Therapeutic plasma exchange (TPE) Selective plasma adsorption Erythrocytapheresis Plateletpheresis Leukapheresis
province and 3 territories). Most centers are located in Québec – 14 and Ontario – 9, while the 3 cities with the largest number of apheresis centers are Montreal – 7, Toronto – 3 and Vancouver – 3. Practically all apheresis clinic units are located in acute care hospitals/centers and are set to provide various apheresis procedures to inpatient as well as outpatient settings. At least 6 apheresis operations are integrated with hemodialysis clinics. Apheresis treatments/ collections are normally provided during the week days (mostly on 8 hour shift). Up to 24 facilities also provide partial or 24/7 on-call services for emergent TPE or RBC depletion/exchanges. The range of types of apheresis procedures can vary from one center to another. Currently, some apheresis units can provide up to 8 different types of therapeutic/collection apheresis. As presented in Table 1, all apheresis centers/clinics except two, perform TPE procedures followed by – in decreasing order: leukapheresis, erythrocytapheresis, plateletpheresis and selective plasma absorption procedures. Depending on the types of the procedures provided, the apheresis centers can be equipped with up to three different type of apheresis devices. In terms of equipment technology, centrifugal blood separators with continuous flow are the mainstay of therapeutic apheresis in Canada. Membrane-type plasma separation is currently used only in devices for low-density lipoprotein apheresis. The apheresis programs are directed by physicians qualified by training and/or experience (often hematologists), and staffed by registered nurses with special training in apheresis. Currently, there are around 227 registered nurses engaged in clinical apheresis operations across Canada, 47% of which are full-time apheresis nurses.
Current issues As in any other nursing practice area, apheresis nurses are facing different challenges related to their practice. Probably the most evident challenges that can be identified in apheresis are nursing training and staffing. These issues are mostly determined by the highly specialized and technical nature of apheresis nursing. Apheresis is a field very much dependent on technology and employs complex automated devices. Use of complex medical devices can lead to adverse events caused by various factors [24,25]. According to the Food and Drug Administration (FDA), up to 9% of medical
Low density lipoprotein-apheresis ABO-specific Immunoadsorption RBC depletion/exchange Platelet depletion PBSC collection Donor lymphocyte collection Leukocyte depletion Bone marrow processing Extracorporeal photopheresis (ECP)
34 2 1 19 8 23 4 25 12 8
device failures are directly related to human errors [26]. A number of studies showed that between 10 and 19% of nurses had used medical devices improperly, and had consequently harmed the patients [27–29]. A study by Kiekkas et al. [30] identified that on the one hand, the increased risk of adverse events associated with use of complex equipment was caused by increased stress, human errors or mechanical faults; on the other hand, the increased stress and human errors was linked to inadequate training. Fouladinejad and Roberts [28] also showed that formal and regular training programs in the use of equipment are important to ensure safe and cost-effective utilization. Some studies also showed that use of complex medical devices causes more than 75% of staff nurses to feel stressed [29]. In this context, it is important to highlight the crucial role of appropriate training and safe nurse staffing in apheresis settings.
Training aspects The apheresis nurses training is built on a core body of nursing knowledge. Advanced training in apheresis is normally focused on principles of apheresis technology, different types of apheresis procedures, operation and troubleshooting of various apheresis systems, specific circulatory access techniques, management of adverse events associated with apheresis, related organizational policies and standard operating procedures. Currently, no academic institution or professional association provides accredited continuing education courses or a certification process for apheresis nurses. Typically, apheresis nurse training consists of orientation provided by the apheresis facility according to the organization’s educational program and SOPs and also training provided by the manufacturers of the apheresis devices. As many centers may perform up to 8 different types of apheresis procedures on different devices, it is often a challenge to maintain the full range of competences, especially when some procedures are rarely done. In cases when an apheresis program is integrated with other programs (i.e. hemodialysis), apheresis nurses are also required to have additional cross-training in the respective field. The development and implementation of standardized, structured educational programs in apheresis and objective evaluation of proficiency can further increase the safety and efficiency of apheresis procedures.
E. Cojocari/Transfusion and Apheresis Science 52 (2015) 137–140
Staffing aspects A growing body of knowledge shows that nursing staffing may significantly impact patient safety and the outcome of patient care as well as the nurse’s satisfaction [31]. Scheduling and staffing in therapeutic apheresis can often be particularly challenging and multifaceted due to the variety of apheresis procedures and apheresis devices employed. Some other factors that may contribute to complexity of the staffing process are:
• • • • • •
Variability in apheresis nurses training. Variability in the patient/donor’s clinical conditions Requirement to provide coverage and perform emergency procedures (i.e. TPE or RBCX) often performed on short notice and after hours. Difficulties to manage temporary staff shortages due to a usually limited pool of trained apheresis nurses. Difficulties in estimating the length and the outcome of some treatments/collections. Procedures performed out of the unit (i.e. inpatient units, operating rooms, other hospitals).
Although nursing staffing approaches may often vary in different apheresis facilities, there is a growing consensus in our professional group that in order to ensure safe and adequate nursing staffing in apheresis settings, the process should be standardized and consistent. Conclusion As therapeutic apheresis has made considerable progresses in the last decades, apheresis nursing has evolved into a distinctive practice area. Today, Canadian apheresis nursing is a relatively small, but growing professional group of practicing nurses with highly specific training. While apheresis continues to evolve and expand its applications, apheresis nurses as a professional group are in a unique position to identify and meet the challenges and opportunities associated with developing and maintaining high standards of care in this area. Acknowledgements Dr. David Barth, University Health Network, Toronto. Dr. Gail Rock, Canadian Apheresis Group, Ottawa. Dr. Hans Messner, University Health Network, Toronto. Jean O’Brien Louis, Canadian Apheresis Group, Ottawa. Karen Witiuk, University Health Network, Toronto. Pamela Harmon, University Health Network, Toronto. Susan Clarke, University Health Network, Toronto. Appendix: Supplementary material Supplementary data to this article can be found online at doi:10.1016/j.transci.2014.12.011. References [1] McLeod BC. Therapeutic apheresis: history, clinical application, and lingering uncertainties. Transfusion 2010;50:1413–26.
139
[2] Schwartz J, Winters JL, Padmanabhan A, Balogun RA, Delaney M, Linenberger ML, et al. Guidelines on the use of therapeutic apheresis in clinical practice – evidence-based approach from the Writing Committee of the American Society for Apheresis: the sixth special issue. J Clin Apher 2013;28:145–284. [3] Abel JJ, Rowntree LG, Turner BB. Plasma removal with return of corpuscles (plasmapheresis). J Pharmacol Exp Ther 1914;5:625– 41. [4] William AR. Late report of the first case of plasmapheresis for Waldenström’s Macroglobulinemia. JAMA 1981;245(6):606–7. [5] Solomon A, Fahey JL. Plasmapheresis therapy in macroglobulinemia. Ann Intern Med 1963;58:789–800. [6] Adams WS, Bland WH, Bassett SH. A method of human plasmapheresis. Proc Soc Exp Biol Med 1952;80:377–9. [7] Tullis JL. Principles involved in glycerolization and deglycerolization of red cells using the Cohn fractionator. In: Proceedings of a conference on plasma proteins and cellular elements of the blood, November 15, 1954. Cambridge (MA): Protein Foundation, Inc. and the Commission on Plasma Fractionation and Related Processes; 1954. p. 17–8. [8] Judson G, Jones A, Kellogg R, Buckner D, Eisel R, Perry S, et al. Closed continuous-flow centrifuge. Nature 1968;217:816–8. [9] Tullis JL, Tinch RJ, Baudanza P, Gibson JG 2nd, DiForte S, Conneely G, et al. Plateletpheresis in a disposable system. Transfusion 1971;11:368–77. [10] Bukowski RM, King JW, Hewlett JS. Plasmapheresis in the treatment of thrombotic thrombocytopenic purpura. Blood 1977;50:413–7. [11] Taft EG. Thrombotic thrombocytopenic purpura and the dose of plasma exchange. Blood 1979;54:842–9. [12] Okuno T, Kosova L. Plasmapheresis for thrombotic thrombocytopenic purpura. Transfusion 1979;19:342–4. [13] Cardella CJ, Sutton D, Uldall PR, de Veber GA. Intensive plasma exchange and renal transplant rejection. Lancet 1977;1:264. [14] Cardella CJ, Sutton DM, Falk JA, Katz A, Uldall PR, deVeber GA. Effect of intense plasma exchange on renal transplant rejection and serum cytotoxic antibody. Transplant Proc 1978;10:617–9. [15] Rifle G, Chalopin JM, Ture JM, Guigner F, Vialtel P, Dechelette E, et al. Plasmapheresis in the treatment of renal allograft rejections. Transplant Proc 1979;11:20–6. [16] Clarke CA, Elson CJ, Bradley J, Donohoe WTA, Lehane D, Hughes-Jones NC. Intensive plasmapheresis as a therapeutic measure in Rhesusimmunised women. Lancet 1970;295(7651):793–8. [17] Graham-Pole J, Barr W, Willoughby ML. Continuous-flow plasmapheresis in management of severe rhesus disease. Br Med J 1977;1(6070):1185–8. [18] Jones JV, Cumming RH, Bacon PA, Evers J, Fraser ID, Bothamley J, et al. Evidence for a therapeutic effect of plasmapheresis in patients with systemic lupus erythematosus. Q J Med 1979;48:555–76. [19] Jones JV, Cumming RH, Bucknall RC, Asplin CM. Plasmapheresis in the management of acute systemic lupus erythematosus? Lancet 1976;1:709–11. [20] Vallejos CS, McCredie KB, Brittin GM, Freireich EJ. Biological effects of repeated leukapheresis of patients with chronic myelogenous leukemia. Blood 1973;42:925–33. [21] McCredie KB, Hersh EM, Freireich EJ. Cells capable of colony formation in the peripheral blood of man. Science 1971;171:293–4. [22] Körbling M, Burke P, Braine H, Elfenbein G, Santos G, Kaizer H. Successful engraftment of blood derived normal hemopoietic stem cells in chronic myelogenous leukemia. Exp Hematol 1981;9:684– 90. [23] Goldman JM, Johnson SA, Catovsky D, Wareham NJ, Galton DA. Autografting for chronic granulocytic leukemia. N Engl J Med 1981;305:700. [24] Amoore J, Ingram P. Learning from adverse incidents involving medical devices. Nurs Stand 2003;17(29):41–6. [25] Grant L. Medical equipment. Devices and desires. Health Serv J 1998;108(5603):34–5. [26] Stephenson GM, Freiherr G. User training and human factors design: solutions for device failures. Med Device Diagn Ind 1990;12(9):50–3, 88. [27] Douglas MR, Leigh JA, Douglas CH. UK registered nurse medical device education: a comparison of hospital and bank nurses. Nurse Educ Pract 2001;1(2):85. [28] Fouladinejad F, Roberts JR. An analysis of training activities in the use of critical care equipment within hospitals in the United Kingdom. Anaesthesia 1998;53:810–22. [29] McConnel EA, Fletcher J. Agency registered nurse use of medical equipment: an Australian perspective. Int J Nurs Stud 1995;32(2):149–61.
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E. Cojocari/Transfusion and Apheresis Science 52 (2015) 137–140
[30] Kiekkas P, et al. Use of technological equipment in critical care units: nurses’ perceptions in Greece. J Clin Nurs 2006;15(2):178– 87. [31] Aiken LH, Clarke SP, Sloane DM, Sochalski J, Silber JH. Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. JAMA 2002;288(16):1987–93.
Eduard Cojocari Listening Post Editor and Apheresis Nurse, University Health Network, Toronto, Ontario, Canada Tel.: (1) 647-995-6911 E-mail address: [email protected]
