title: Ultrasound-guided peripheral deep vein cannulation to perform automated red cell exchange-A pilot study in a single centre.
abstract: BACKGROUND
  Securing adequate vascular access is essential for a successful apheresis procedure. In most, peripheral access is preferred but it is not always technically possible. Ultrasound-Guided Peripheral Vascular Access (USG-PIVA) is a well-documented technique in the setting of Emergency departments. However, limited data exists reporting its use in the context of automated red cell exchanges (a-RCEx).
  
  
  OBJECTIVE
  To assess the effectiveness and feasibility of USG-PIVA to undertake successful a-RCEx.
  
  
  METHODS
  Data was collected prospectively from patients with sickle cell disease and difficult venous access, undergoing a-RCEx at a single centre. The USG-PIVA technique was attempted and data relating to each attempt was collected and analysed.
  
  
  RESULTS
  Between April 2014 and July 2015 84 USG-PIVA procedures were performed on 38 patients. 71 USG-PIVA (85%) were successful, 13 (15%) were unsuccessful. Veins successfully cannulated: in the upper arm, basilic (22), brachial (33) and cephalic (2) veins; in the antecubital fossa, basilic (3) and median cubital (7) and in the lower arm, cephalic (2) and radial (2). Cannulas used: Introcan Safety® Braun 22 g (1), 20 g (9) and 18 g (61). Inlet flow rates achieved: 30-60 ml/min (mean 45 ml/min). Depth of veins cannulated: 2-12 mm (mean 5 mm). two complications were observed-one cannula displacement and one nerve injury. No arterial punctures occurred. Central Venous Catheters avoided (49).
  
  
  CONCLUSIONS
  The US-PIVA method offers an effective alternative to Central Venous Access in patients requiring a-RCEx procedures who lack visual or palpable peripheral access, with minimal complications seen in this series. J. Clin. Apheresis 31:501-506, 2016. © 2015 Wiley Periodicals, Inc.
authors.affiliation: Apheresis Department, Macmillian Cancer Centre, University College London Hospitals, London.
authors.forename: Daniel
authors.initials: D
authors.lastname: Putensen
authors.affiliation: Apheresis Department, Macmillian Cancer Centre, University College London Hospitals, London.
authors.forename: Linda
authors.initials: L
authors.lastname: Pilcher
authors.affiliation: Apheresis Department, Macmillian Cancer Centre, University College London Hospitals, London.
authors.forename: Dawn
authors.initials: D
authors.lastname: Collier
authors.affiliation: Apheresis Department, Macmillian Cancer Centre, University College London Hospitals, London.
authors.forename: Karen
authors.initials: K
authors.lastname: McInerney
mesh_terms: D000755:Anemia, Sickle Cell / Q000628:therapy; D001132:Arm / Q000098:blood supply*; D001331:Automation; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000379:methods*; D017707:Erythrocyte Transfusion / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D061214:Patient Safety; D010865:Pilot Projects; D011446:Prospective Studies
keywords: apheresis; erythrocytapheresis; sickle cell disease; ultrasound-guided peripheral venous access