Prospective investigation of a subcutaneous, implantable central venous access device for therapeutic plasma exchange in adults with neurological disorders.
Standard alternatives to antecubital access for long-term therapeutic plasma exchange, including percutaneous polyurethane or tunneled silicone catheters, are associated with complications and inconvenience for the patient. We have investigated the Bard CathLink 20, a subcutaneously implantable central venous access device, as an alternative for outpatient plasma exchange. The CathLink 20 consists of a funnel-shaped titanium port connected to a soft polyurethane-derived catheter and is accessed percutaneously using an 18-gauge catheter-over-needle Angiocath. Six patients with paraproteinemic polyneuropathies underwent 64 outpatient plasma exchanges using the CathLink 20 for access, 31 using 2 CathLink 20's (draw and return), 20 using a single CathLink 20 as the draw site and 13 using a single CathLink 20 as the return site. Mean (+/- SD) plasma removed was 3,680 +/- 551 ml in 115.2 +/- 25.3 min. Apheresis personnel were able to access the ports in 1.23 +/- 0.6 attempts per port per procedure. Six of 70 planned procedures were aborted: 3 because of failure of an antecubital access site and 3 because of catheter occlusion resolved using a thrombolytic agent. Whole blood flow rate was approximately 54 ml/min, and plasma flow rate was about 32 ml/min for 135 min. Access pressures were stable at -150 to -200 torr (P = 0.1395). Return line pressures varied between 90 and 130 torr (P = 0.0147). No patient required hospitalization during the study. Though not optimized for apheresis, the CathLink 20 provides a reasonable option for chronic apheresis patients who lack adequate peripheral venous access.
Pertiné
Basilio
B
Department of Medicine, Division of Hematology/Oncology, Section of Hematology and Transfusion Medicine, St. Elizabeth's Medical Center of Boston, Tufts University School of Medicine, 736 Cambridge Street, Boston, MA 02135, USA.
Razvi
Syed A
SA
Weinstein
Robert
R
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D000925:Anticoagulants / Q000627:therapeutic use; D001783:Blood Flow Velocity; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000295:instrumentation*; D002408:Catheters, Indwelling; D005260:Female; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D010265:Paraproteinemias / Q000276:immunology / Q000628:therapy*; D010342:Patient Acceptance of Health Care; D010951:Plasma Exchange / Q000295:instrumentation*; D011115:Polyneuropathies / Q000276:immunology / Q000628:therapy*; D011312:Pressure; D011446:Prospective Studies; D015912:Thrombolytic Therapy
D000925:Anticoagulants; D006493:Heparin