Platelet Rich Fibrin (PRF)

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Preoperative Considerations

Consent:

  • Pain
  • Bruising
  • Lightheadedness
  • Phlebitis
  • Possible need for multiple blood draws

Anesthesia/Positioning:

  • Fowler's position
  • Consider Trendelenburg position with head below heart to prevent syncope in susceptible patients

Other:

  • In order to allow for only 1 IV access site, butterfly catheter can be attached to heparin lock or IV extension tubing after Vacutainer collection device is removed. This will then allow an IV fluid line to be attached and used for administration of sedative drugs. Exactly compatibility will vary based on manufacturer.
  • Alternatively, blood can be drawn directly from a traditional IV catheter if it is first attached to an IV extension line (4" or longer). Extension tubing prevents collapse and dislodgment of IV catheter when negative pressure is applied to draw blood. Blood can be drawn into 10cc syringes and then injected into Vacutainer tubes through rubber access port. Extension tubing can then be attached to IV fluid line and used for administration of sedative drugs.
  • If using extension tubing, do not forget to prime it with sterile isotonic IV fluid before connecting to a catheter or existing IV line
  • Make sure centrifuge is powered on and programed to desired settings before drawing blood. Centrifugation should begin as soon as possible after blood is drawn (no more than 2 minutes)
  • Tubes must be placed into centrifuge in a counterbalanced configuration for proper centrifuge function (i.e. each tube should have another tube of equal weight directly across from it in the centrifuge). If an odd number of PRF tubes are being centrifuged, a tube with 10cc saline can be used for counterbalancing.

Armamentarium:

  • Liquid and solid PRF tubes (colors vary by manufacturer)
  • Butterfly needle with Vacutainer collection attachment
  • Heparin lock or IV extension tubing (if single venous access site is also used for sedation)
  • Centrifuge
  • Scissors
  • Empty 3cc syringe (1 for each vial of liquid PRF created)
  • PRF tray and compactor

Technique

After cleansing skin, venous access is obtained with Butterfly needle attached to Vacutainer collection system
Tube of desired PRF type is attached to Vacutainer collection system and approximately 10cc of whole blood is drawn
Tubes are placed into centrifuge in a counterbalanced configuration
Centrifuge is run at desired settings based on manufacturer recommendations
Example of solid PRF clot after centrifugation with attached erythrocyte layer
Erythrocyte layer is separated as completely as possible from PRF clot using scissors

PRF clot is placed on perforated tray
Cover is placed on perforated tray overlying PRF clot

After several minutes, PRF clots have been flattened into membranes, which aids in handling. PRF membranes are then used for desired clinical application.

Postoperative Considerations

Immediate:

  • Dress venous access site with standard compression dressing after catheter removal

Follow Up:

Operative Note

Coding

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