Clinical Perfusion is a profession of Allied health care. A Perfusionist holds numerous roles throughout the hospital. The main scope of practice is running the heart-lung machine in open heart surgery. Extra corporeal membrane oxygenation (ECMO), and ventricular assist devices (VAD) are other devices Clinical Perfusion takes care of for short or long term support. Ancillary devices include cell salvage, running point of care instruments, helping with invasive line monitoring, intra-aortic balloon pumps, and autologous platelet gel. All of these utilities allow us to provide care to not only surgical patients in the operating room, but elsewhere in surgical ICUs and outpatient facilities with opportunities in the veterinary field as well. Our particular group is contracted out to several hospitals in the Heart of Illinois area. The Clinical Perfusionist helps play a major role in wound care healing by utilizing autologous platelet gel (APG) therapy or PRP therapy.
Autologous platelet gel was developed in the early 1990’s as a byproduct of multicomponent pheresis. The science behind the product is the many properties of the patient’s own blood which are put into a concentrated form. Platelet growth factors, white blood cell growth factors, and plasma growth factors allow for rapid healing. Many other growth factors play an important role as well. Essentially the product creates a response similar to an actual traumatic experience causing compliment activation of the wound site. This happens due to fibrin strands that activate the platelet membrane. The platelets have signal proteins; which signals white blood cells to fight infection and promote growth.
The steps to the autologous platelet therapy are shown here. The Perfusionist enters into the pre-op area and draws 20-110mL of whole blood from the patient depending on the size of wound. Usually there is a nurse available to start an 18 gauge catheter in order to draw the blood. It is important to utilize an 18 gauge catheter as this prevents the least activation of platelets while drawing the blood. If for any reason no catheter is placed in the pre-op area the next easiest blood draw would partake in the operating room; or at the location of wound care such as the office or outpatient area. Blood is collected in 55mL syringes with ACD for anticoagulation. The blood is then taken to be processed in a centrifuge. The device is portable and is wheeled into the patient room or nearby location. The centrifuge separates the blood out into plasma, buffy coat (which contains the platelets), and red blood cells. The plasma part called the platelet poor plasma (PPP) and the buffy coat part called platelet rich plasma (PRP) are separated into two different syringes. At this point, the blood is still anticoagulated from the initial blood draw. In preparation of giving the autologous platelet gel there are sterile applicator kits that are handed up to the sterile field for the nurse to put together. The PPP and PRP are handed off and drawn up in sterile 10mL syringes. 5000units of Thrombin and 0.5grams of Calcium Chloride are also mixed and handed up. This combination of Thrombin and CaCl are drawn into a 1mL syringe. The PPP and Thrombin mix are attached to an applicator tip; likewise, the PRP and Thrombin mix are attached to different applicator tip. Once the surgery is done or the injection site is prepared, the PRP is inserted directly into the wound site. There are different techniques of doing this. The Thrombin mix activates the PRP in order to create a gel which stays in place. Once the wound is closed the PPP is then sprayed over the incision to create a sealed layer. PPP can also be utilized inside the wound along with PRP for compliment healing and decrease in infection. The whole process of creating the PPP and PRP takes about 20minutes and the application takes seconds to apply and gels up instantly.
Application of autologous platelet therapy ranges from burns, chronic diabetic wounds, orthopedics, and surgeries to (oral, fasciitis, and plastics). Our group experience has provided a variety of successful applications. Four years ago we started this autologous platelet therapy in our open heart case for sternal wound closure and vein harvest. As of now we have yet to see a sternal wound infection or bring back due to any infection. On average as prior to this there were bring backs due to infection about once every four months. The cost of a sternal wound infection rises above $300,000; therefore, by cutting the infection rate to zero, the amount of cost savings has been very beneficial. The rate of healing in three days looks like a wound that has been healing for five days. This is particularly great with plastics by having minimal bruising and less swelling with the use of PRP. The PRP can be made clear so that no scaring is seen from the hemoglobin of the red blood cells. PRP is dark in some cases because it allows for more platelets in the gel product. The technique is to draw the upper layer of red blood cells in the separated layers of the whole blood. Newly formed red blood cells have the same mass as platelets; therefore, in a centrifuge setting all of the platelets will be utilized by taking the buffy coat and the top layer of red blood cells. Recently new studies have shown there to be some stem cells in the platelet gel. In one instance we were able to heal plantar fasciitis with PRP injection. Tennis elbow has even been healed with PRP injections. In a recent experience we had a burn victim who had gone through major skin grafting. The area of the grafts showed expedited healing. In oral surgery bone grafting of newly remodeled bone allowed for superior growth of new bone in preparation for implantation.
- How much does autologous platelet therapy cost? The cost is minimal compared to the cost of longer ICU times or problems that arise from infections.
- Does insurance cover PRP? Currently the FDA is getting closer in covering PRP cost as it is a preventative tool as well as shorter length of stay for many patients.
- In an outpatient procedure what resources would I need? Have a Sharps container and surgical waste container to dispose properly of the disposables.
- What is in it for me? Faster healing times with less pain and bruising which creates more referrals and better outcomes.
- How long would it take? 20 minutes for processing of the PRP and PPP that can be done prior to surgery. Application takes seconds to apply.
- How long is the product good for? AABB states it is good for 6 hours prior to use.
- Who can apply the product? Doctor, Nurse, Perfusionist, or Tech can, anyone with proper training.
- What do I need to do to be prepared? When you are ready to start an IV, you want an 18gauge catheter. When the catheter is in place then Perfusion will draw the blood off and hook up the IV once finished. If no IV will be started, your assistance will may be needed with the stick for a blood draw.
- How long does this take from my time? Typically this process takes 2 minutes.
- What do I need to tell the patient? The Perfusionist will be in to take some blood for autologous platelet therapy for your incision site or wound closure. The Perfusionist will also explain how the therapy works while drawing off the blood.
- How do I put the disposables together? The Perfusionist will be there for you to show you how to assemble the products.
- How long does this assembly take? The assembly is simple and takes no more than 4 minutes the first time. Once you have done it once the next time goes a lot faster.
- When do I assemble the disposables? The disposables can be assembled right away even before the patient enters the room. Once the PRP and PPP are handed up to the sterile field then assembly takes place and the samples are set aside until ready to use.
- How can I get Autologous Platelet Therapy? Ask your doctor about the therapy and he or she can contact Clinical Perfusionist through Life Services Inc. at 309-397-8704. Or you can call directly.
- What will this Therapy do for me? The Therapy helps with faster healing times, less bruising, and even less pain.
Brycen McMullen MPS,CCP,LP
Life Services Inc