Long-term therapeutic plasma exchange in the outpatient setting using an implantable central venous access device
Department of Medicine, Transfusion Medicine Section, Caritas St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA 02135, USA. Journal of Clinical Apheresis
(Impact Factor: 1.79).
01/2004; 19(4):180-4. DOI: 10.1002/jca.20024
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.
Available from: Marisa Bicca Marques
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ABSTRACT: Photopheresis has become a key component in the therapeutic armamentarium of cutaneous T-cell lymphoma, graft-versus-host disease following stem cell transplant, and allograft rejection of solid organs such as heart. Although it is considered a new treatment modality in its present form, the field of phototherapy dates back thousands of years. In this review, the reader will learn more about the history of photopheresis and how it became a therapeutic alternative for patients with solid organ transplants. An extensive literature search will highlight the evidence-based benefits of photopheresis (or lack thereof). A discussion of the mechanism of action of photopheresis and the technical aspects of the procedure will also be covered. Since photopheresis may be the best tolerated form of immunomodulation, current promising, albeit preliminary data on its efficacy warrant further investigation and understanding.
Available from: ncbi.nlm.nih.gov
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