ISSN 1866-8836
Клеточная терапия и трансплантация

N-03. The role of nurse in extracorporeal photopheresis

Yuliya V. Mirenkova                        

The Republican Research Center for Pediatric Oncology, Hematology and Immunology, Minsk, Republic of Belarus


Contact: Yuliya V. Mirenkova, e-mail: mirenkova@oncology.by

doi 10.18620/ctt-1866-8836-2023-12-3-1-176

Summary

In world medicine, the progress in treatment of hematological oncologic diseases has been made, due to usage of allogeneic hematopoietic stem cell transplantation (HSCT). However, graft-versus-host disease (GvHD), the most common complication of HSCT, causes deterioration in the quality of patients’ life and often leads to death. The prevalence of this disorder is from 30 to 70% and it depends on many factors. Immunosuppressive therapy is the main treatment option for GvHD. Treatment-resistant patients have an unfavorable prognosis, and they require a second-line treatment which includes the methods of extracorporeal photopheresis (ECP). Advantages of ECP are as follows: good tolerability, safety, absence of noticeable side effects. Clinical nurses assisting at the extracorporeal photochemotherapy should have high competence, theoretical and practical training in high medical technologies and high-quality performance of medical procedures. Purpose of our work was to master knowledge in extracorporeal photopheresis management and to promote the nursing care in the therapy of patients with posttransplant complications, e.g., GvHD.

Materials and methods

We performed the procedures in accordance with Regulatory legal acts and documents of the Ministry of Health of the Republic of Belarus, local regulatory documents. Over 2020-2023 we performed 288 ECP procedures in 35 patients.

Results and discussion

ECP is a multi-stage therapeutic procedure, whose main mechanism of action is realized through apoptosis of mononuclear cells. The technique is based on the method of apheresis which is aimed to collect peripheral blood mononuclear cells from patient’s blood, then treated with a photoactive drug (8-MOP/Methoxsalen), irradiated with ultraviolet light and, finally, the treated cells are returned to the patient. During the irradiation procedure, the cells causing pathological immune reactions die or lose their activity. ECP can significantly improve life quality and general condition of patients with GvHD, and can reduce the dose of GCS up to complete withdrawal. There are two ECP methods determined only by different equipment used for it. The nurse at the Transfusion Department cares for patient preparing for the procedure and directly participates in its implementation. She is required to have thorough theoretical knowledge of procedure features and practical training in operating the equipment. The nurse deals with preparation of collected cells for reinfusion and provides the necessary assistance to a patient during the ECP procedure conducting an explanatory conversation, ensuring patient convenience and comfort. She provides venous access, prepares the blood cells for irradiation, connects reinfusion, monitors patient condition, follows the rules of aseptics at every stage of the procedure.

Conclusion

The recovery of a patient with complications after HSCT undergoing extracorporeal photochemotherapy largely depends on high-quality nursing care and timely and competent medical care provided by a nurse. Professional competency of the nurses is an important condition for patient recovery.

Keywords

Extracorporeal photopheresis, allogeneic hematopoietic stem cell transplantation, graft-versus-host disease.


Supplement 12-3
09/30/2023

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doi 10.18620/ctt-1866-8836-2023-12-3-1-176

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