title: Long-term therapeutic plasma exchange in the outpatient setting using an implantable central venous access device.
abstract: We presented the results of our prospective trial of the Bard CathLink 20 in outpatient therapeutic plasma exchange in May 2000. Since the close of that study, three of the original subjects and one additional subject have received continuous outpatient treatment using the device. We report herein on its long-term use. Four patients with demyelinating polyneuropathy underwent outpatient plasma exchange of 1-1 1/4 plasma volumes using Bard CathLink 20 venous access devices for up to 2 1/2 years. Treatment schedules varied according to the status of the patient's neuropathy. Four men (age 59, 60, 76, 79) underwent 55, 56, 38, and 41 plasma exchanges over 18.5, 18, 20, and 38.5 months, respectively, all in the outpatient setting. Ninety-one percent were completed in <150 min (mean 120 +/- 28 min) with 3,783 +/- 314 ml of plasma removed. Mean access flow rates were approximately 70 +/- 11 ml/min. Plasma flow rates were approximately 38 +/- 6 ml/min. (During our original 6-month prospective trial, access and plasma flow rates were approximately 54 and 32 ml/min, respectively). There were no adverse effects resulting from use of the CathLink and no hospitalizations were needed for plasma exchange. Pressure alarms were infrequent. Access and plasma flow rates achieved with the CathLink 20 have increased by about 30 and 16%, respectively, with long-term use. The conclusion from our prospective trial of this device, that it could conveniently be used for long-term outpatient plasma exchange, is supported by our follow-up experience.
authors.affiliation: Department of Medicine, Transfusion Medicine Section, Caritas St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA 02135, USA.
authors.forename: Anneliese
authors.initials: A
authors.lastname: Gonzalez
authors.forename: Donata
authors.initials: D
authors.lastname: Sodano
authors.forename: Janice
authors.initials: J
authors.lastname: Flanagan
authors.forename: Cindy
authors.initials: C
authors.lastname: Ouillette
authors.forename: Robert
authors.initials: R
authors.lastname: Weinstein
mesh_terms: D000368:Aged; D001781:Blood Component Removal / Q000295:instrumentation* / Q000379:methods*; D002405:Catheterization, Central Venous; D002986:Clinical Trials as Topic; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010951:Plasma Exchange / Q000295:instrumentation* / Q000379:methods*; D013997:Time Factors