Vascular Access

Think peripheral access first

Patient safety is a priority. Consider using peripheral access for your apheresis procedures.

"Peripheral venous access is underutilized in therapeutic apheresis procedures and is the access of choice due to the relatively low rate of serious complications.¹"

Access training now

Did you know?

Apheresis procedures

The majority of apheresis procedures can be performed successfully with peripheral veins.²

Peripheral access

In several studies, apheresis procedures were performed peripherally in 64.3%³  to 94.6%⁴ of cases.² In some cases, peripheral access may not be feasible.⁵˒⁶

Spectra Optia

Red blood cell exchange and plasma exchange can be performed via single-needle or dual-needle peripheral access on the Spectra Optia™ Apheresis System. Not all options are available in all regions.

Vascular access in elective therapeutic apheresis²

USG-PIVA: Ultrasound-guided peripheral venous access

The chart shows the use of vascular access in elective therapeutic apheresis (including autologous and allogeneic hematopoietic progenitor cell harvest, mononuclear cell harvest, automated red blood cell exchange, therapeutic plasma exchange, and white blood cell depletion) and elective procedures as compared to emergency procedures.

Add to your knowledge and help optimize patient care with these best practices, resources, and education opportunities.

Putting peripheral venous access in action

By encouraging vein assessment as a standard practice before every apheresis procedure, you can help ensure that peripheral access is always considered as an option to meet a patient’s individual needs.

The impact of ultrasound-guided peripheral access

The use of ultrasound-guided peripheral venous access prevented the placement of central venous catheters in 20% of procedures, demonstrating its utility in a busy apheresis clinic.⁷

"In patients with difficult peripheral venous access, ultrasound guidance increased success rates of peripheral venous placement when compared with traditional techniques."⁸

Peripheral venous access tips and tricks

These handy tips and tricks can help when you are performing peripheral access.

The information presented below is for your consideration only. Always follow your facility’s standard operating procedure for obtaining venous access.

Patient preparation and education

Perform a venous assessment
Set expectations — it may take more than one attempt to gain venous access
Educate your patients about:
- Hydration prior to apheresis
- Exercise when possible (for example, flexing fingers)
- Use of topical anesthetics

Choosing needle gauge and flow rates

Select a needle or angiocatheter that will support the chosen flow rate.

Flow rates may vary based on the patient characteristics.

17 gauge: 80 mL/min and above
18 gauge: 70 mL/min and above
19 gauge: 60 mL/min and below

Vein selection and venipuncture

Assess arms for potential venipuncture sites
Palpate and visualize the vein for location, direction, and depth
Select a vein that will accommodate the needle size chosen

Prior to performing the venipuncture:

Warm the venous site
Position the patient’s arm in a natural position
Use distraction techniques when inserting the needle
Stay calm
Secure the needle; do not tape butterfly wings
Use an ultrasound-guided technique, if available

Maintain steady flow rates during the procedure

Use a blood pressure cuff or a tourniquet
Check the position of the patient’s arm and needle insertion sites
Encourage the patient to squeeze a ball or squeezer
Keep the patient warm
Warm the patient’s arm above and below the access site

Troubleshooting pressure alarms

Slow down the inlet pump flow rate
Ask the patient to squeeze
Check the pressure in the blood pressure cuff
Reposition the patient’s arm or the needle position
Verify the flow rate is appropriate for the vein and needle gauge
Ensure the patient is comfortable, warm, and calm
Check for obstructions along the inlet/return line
Establish alternate access

Repeated inlet/return pressure alarms on Spectra Optia

May cause the pumps to pause
May lengthen the procedure time
May cause clotting in the inlet site
Could lead to an inefficient procedure
10 access alarms can increase your procedure by 15 to 20 minutes

Note: Pressing the Continue button without any other action will not fix the issue.

Featured resources

Audio & Video
Documents
Links
Trainings

Procedure Instruction

25 mins

Venous System Overview and Basics of Peripheral Venous Access

Gain knowledge on peripheral intravenous insertion essentials, including variables that make a patient the right candidate for peripheral access

Start now

Procedure Instruction

15 mins

How to Establish Peripheral Venous Access

Learn about the steps for successful peripheral access, preparing the patient and access site, and properly inserting the access device

Start now

Procedure Instruction

15 mins

Managing the Potential Complications of Peripheral Venous Access

Learn about common complications that can occur when gaining peripheral venous access, such as infiltration, and ways to lower the risk

Start now

Procedure Instruction

25 mins

Foundation of Ultrasound-Guided Peripheral Venous Access

Explore techniques for using ultrasound guidance for more precise and lower-risk peripheral venous access

Start now

Case Study

2 pg

Increasing Peripheral Access to Reduce Risk and Treatment Delays

Learn how Johns Hopkins Hospital more than doubled the number of RBCX procedures using peripheral access over central lines

Read now

Case Study

2 pg

Advancing Peripheral Access for Apheresis With Ultrasound

See how Aarhus University Hospital in Denmark increased peripheral access from 50% to 99% via use of an ultrasound-guided cannulation technique

Read now

Article ⁄Abstract

1 pg

Vascular Access in Therapeutic Apheresis

Learn about the types of vascular access available for patients who need therapeutic apheresis

Read now

Article ⁄Abstract

4 pg

Long-Term Use of Antecubital Veins for Plasma Exchange

Read about a randomized clinical trial with patients undergoing weekly plasma exchange for up to 20 weeks using superficial antecubital veins

Read now

Article ⁄Abstract

3 pg

Venous Access: A Practical Review for 2009  

This review provides insight into the variety of options available for venous access

Read now

Article ⁄Abstract

5 pg

Safety of Plasma Exchange Therapy in Patients With Myasthenia Gravis

Review results of a study comparing data from plasma exchange treatments versus intravenous immunoglobulin (IVIg)

Read now

Article ⁄Abstract

6 pg

Improved Care and Reduced Costs for Patients Requiring Peripherally Inserted Central Catheters: The Role of Bedside Ultrasound and a Dedicated Team

Review this prospective quality assurance study, intended to determine if a team dedicated to placing peripherally inserted central catheters (PICCs) would improve patient care and reduce costs.

Read now

Article ⁄Abstract

4 pg

Ultrasound-Guided Peripheral Venous Access for Therapeutic Apheresis Procedures Reduces Need for Central Venous Catheters

Read a review of patients undergoing apheresis over a three-month period to assess the benefit of ultrasound-guided peripheral venous access

Read now

Article ⁄Abstract

7 pg

Is Peripheral Access for Apheresis Procedures Underutilized in Clinical Practice? A Single Centre Experience

Review this study to establish the feasibility and suitability of peripheral access for different apheresis procedures undertaken in elective or emergency settings

Read now

Professional organization

1 pg

Association for Vascular Access (AVA) 

Visit the website for the AVA, an organization of healthcare professionals founded to support and promote vascular access

Learn more

Professional organization

1 pg

National Infusion and Vascular Access Society (NIVAS) 

Visit the website for NIVAS, an independent society acting as a voice for those involved in vascular access and infusion therapies

Learn more

Are you interested in learning more about optimizing your peripheral access?

Connect with our experts

Disclaimers and notes

1. Golestaneh L, Mokrzycki MH. J Clin Apher. 2013;28(1):64-72.  

2. Putensen D, et al. J Clin Apher. 2017;32(6):553-559.

3. Mortzell Henriksson M, et al. Apher Sci. 2016;54(1):2-15.

4. Noseworthy JH, et al. Transfusion. 1989;29(7):610-613.  

5. Stegmayr B, Wikdahl A. Ther Apher Dial. 2003;7(2):209-214.

6. Schonermarck U, Bosch T. Ther Apher Dial. 2003;7(2):215-220.

7. Salazar E, Garcia S, Miguel R, Segura FJ, Ipe TS, Leveque C. Ultrasound-guided peripheral venous access for therapeutic apheresis procedures reduces need for central venous catheters. J Clin Apher. 2017;32(4):266-2697.

8. Stolz LA, Stolz U, Howe C, Farrell IJ, Adhikari S. Ultrasound-guided peripheral venous access: a meta-analysis and systematic review. J Vasc Access. 2015;16(4):321-326.

Additional referenced materials

Cheung E, Baerlocher MO, Asch M, Myers A. Praxic, Venous access: a practical review for 2009. Can Fam Physician. 2009;55(5):494-496.

Ebadi H, Barth D, Bril V. Safety of plasma exchange therapy in patients with myasthenia gravis. Muscle Nerve. 2013;47(4):510-514.

Golestaneh L, Mokrzycki MH. Vascular access in therapeutic apheresis: update 2013. J Clin Apher. 2013;28(1):64-72.

Mortzell Henriksson M, Newman E, Witt V, et al. Adverse events in apheresis: an update of the WAA registry data. Transfus Apher Sci. 2016;54(1):2-15.

Noseworthy JH, Shumak KH, Vandervoort MK. Long-term use of antecubital veins for plasma exchange. Transfusion. 1989;29(7):610-613.

Putensen D, Leverett D, Patel B, Rivera J. Is peripheral access for apheresis procedures underutilized in clinical practice?—A single centre experience. J Clin Apher. 2017;32:553-559. 

Robinson MK, Mogensen KM, Grudinskas GF, Kohler S, Jacobs DO. J Parenter Enteral Nutr. 2005;29(5):374-379.

Schonermarck U, Bosch T. Vascular access for apheresis in intensive care patients. Ther Apher Dial. 2003;7(2):215-220.

Stegmayr B, Wikdahl A. Access in therapeutic apheresis. Ther Apher Dial. 2003;7(2):209-214.

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Vascular Access: An Overview

Facts and insights about the use of peripheral vascular access for therapeutic apheresis

Think peripheral access first

Did you know?

Apheresis procedures

Peripheral access

Spectra Optia

Vascular access in elective therapeutic apheresis²

Add to your knowledge and help optimize patient care with these best practices, resources, and education opportunities.

Putting peripheral venous access in action

The impact of ultrasound-guided peripheral access

Peripheral venous access tips and tricks

Patient preparation and education

Choosing needle gauge and flow rates

Vein selection and venipuncture

Maintain steady flow rates during the procedure

Troubleshooting pressure alarms

Repeated inlet/return pressure alarms on Spectra Optia

Featured resources

Venous System Overview and Basics of Peripheral Venous Access

How to Establish Peripheral Venous Access

Managing the Potential Complications of Peripheral Venous Access

Foundation of Ultrasound-Guided Peripheral Venous Access

Increasing Peripheral Access to Reduce Risk and Treatment Delays

Advancing Peripheral Access for Apheresis With Ultrasound

Vascular Access in Therapeutic Apheresis

Long-Term Use of Antecubital Veins for Plasma Exchange

Venous Access: A Practical Review for 2009

Safety of Plasma Exchange Therapy in Patients With Myasthenia Gravis

Improved Care and Reduced Costs for Patients Requiring Peripherally Inserted Central Catheters: The Role of Bedside Ultrasound and a Dedicated Team

Ultrasound-Guided Peripheral Venous Access for Therapeutic Apheresis Procedures Reduces Need for Central Venous Catheters

Is Peripheral Access for Apheresis Procedures Underutilized in Clinical Practice? A Single Centre Experience

Association for Vascular Access (AVA)

National Infusion and Vascular Access Society (NIVAS)

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Venous Access: A Practical Review for 2009  

Association for Vascular Access (AVA) 

National Infusion and Vascular Access Society (NIVAS) 