Table 1:

Summary of modifications made to the standard therapeutic plasma exchange procedure for use in parallel with cardiopulmonary bypass.

	TPE in Parallel with CPB	Standard TPE Procedure
Priming solution for tubing set	100% saline	ACD-A and saline
Target processed blood volumes	1 – 1.5 blood volumes, or as ordered by physician	1 – 1.5 blood volumes
Replacement fluid	100% FFP	FFP or albumin as determined by indication
Replacement fluid input	Select Albumin/Saline	Select appropriate fluid
Anticoagulation infusion rate	2.5mL/min/L	Maximum rate 1.2mL/min/L
Inlet	142 mL/min	As calculated by machine
Inlet AC ratio	50:1	10:1
TBV	Increase as per physician order to including CPB circuit	As calculated by machine
Inlet and return connections	Inlet connects to venous (draw) line. Return connects to cardiotomy.	Sites determined by central access or vein assessment
Calcium replacement	3x the standard dose, as calcium chloride or calcium gluconate at the anesthesiologist’s discretion	Calcium gluconate 20mg/kg/hour
Calcium goals	iCal goal range 0.8–1.3mmol/L	iCal goal range 1.1–1.3mmol/L
Additional materials	Extra accessory waste bag available due to high volumes removed	-
Additional personnel	Secondary operator/provider present to assist with rapid exchange rate and documentation	-

Abbreviations: TPE: therapeutic plasma exchange, CPB: cardio-pulmonary bypass, TBV: total blood volume, ACD-A: anticoagulant citrate dextrose solution, AC: anticoagulation, FFP: fresh frozen plasma, mL: milliliter, mg: milligram, kg: kilogram, min: minute, L: liter, mmol: millimole, hr; hour.