Improving the service for patients receiving extracorporeal photopheresis using Lean principles.

The photopheresis unit where the authors work has seen an increased demand both locally and as an outreach service. A Lean assessment of the unit was undertaken to improve processing time and productivity, which in turn would improve the availability of treatment and improve patient care. The assessment indicated that there were excellent nursing standards and patient care; however, patient waiting times and treatment times were prolonged in comparison with other units. The unit reviewed the patient pathway and identified where delays occurred and consequently changed patient scheduling.

Care for patients undergoing extracorporeal photopheresis to treat chronic graft-versus-host disease: review of the evidence.

Late immune dysregulation following allogeneic hematopoietic cell transplantation (HCT) is known as chronic graft-versus-host disease (GVHD), which is a major cause of mortality and morbidity after HCT, and a rise in its incidence is predicted. Better therapies are being sought to manage chronic GVHD and limit patients' exposure to corticosteroids. Extracorporeal photopheresis (ECP), an immune-modulating therapy, has shown preliminary safety and efficacy in treating chronic GVHD. However, access to ECP is limited, care is costly, and the optimal frequency, duration, and durability of response are unknown. Although nurses who care for patients with chronic GVHD recognize its adverse impact on patients' quality of life, limited evidence exists about the selection of patients most likely to benefit from ECP therapy and from the supportive care provided to them. A multidisciplinary approach is needed to define the desired outcomes of ECP therapy and to determine the evidence base for nursing management approaches.

Erythrodermic CTCL: a case study of treatment with extracorporeal photopheresis.

Erythrodermic cutaneous t-cell lymphoma (CTCL) is an aggressive variant of CTCL with multiple skin manifestations and symptoms. A brief overview of CTCL and a case study of one patient with erythrodermic CTCL who underwent successful treatment in a research protocol with extracorporeal photopheresis and UVADEX are presented. Nursing care, critical for patients with erythrodermic CTCL, is also described.

Photopheresis and the role of the nurse.

Extracorporeal photochemotherapy (ECP, photopheresis) is a form of pheresis therapy approved by the federal Food and Drug Administration for treating the systemic manifestations of cutaneous T-cell lymphoma. Increasing evidence suggests that it may also be useful in treating many immune-related diseases, as well as in preventing and treating organ transplant rejection. Because the precise mechanism of action for photopheresis has not been clearly defined, research to determine future applications for this treatment is needed. It is important for dermatology nurses to understand photopheresis, to whom it is given, the nursing care for patients receiving photopheresis, and the current research and potential applications of this therapy.

Use of extracorporeal photochemotherapy in heart transplant recipients during acute rejection: a case study.

Despite the growing availability of improved immunosuppressive agents, acute and chronic rejection episodes remain a major complication in heart transplant recipients. The rejection of allografts is a normal part of the body's response to foreign antigens. The key to controlling this response is to administer a regimen of multiple immunosuppressive drugs. Evidence indicates that by adding extracorporeal photochemotherapy to a standard immunomodulatory regimen, the rejection process can be reversed without significantly increasing patient risk. In this case study we examine extracorporeal photochemotherapy and the care of patients receiving this therapy.