Prospective investigation of a subcutaneous, implantable central venous access device for therapeutic plasma exchange in adults with neurological disorders

Vascular access considerations for extracorporeal photopheresis

Extracorporeal photopheresis is an immunomodulatory therapy indicated for patients with cutaneous T-cell lymphoma, graft-versus-host disease, and heart or lung allograft rejection. Whole blood from the patient is drawn into the photopheresis instrument where it is separated into its components. Plasma, red blood cells, and the treated buffy coat are subsequently returned to the patient. Consistent, adequate blood flow is necessary to successfully complete the procedure. Vascular access options for photopheresis include peripheral vein cannulation, tunneled central venous catheters, and subcutaneous ports. Photopheresis is a very safe procedure; however, the complications and impact on the patient's quality of life associated with vascular access devices can be significant.

Implanted vascular access device options: a focused review on safety and outcomes

Implantable vascular access devices are frequently used in patients who have poor peripheral venous access. These devices can be partially implanted as tunneled and nontunneled central catheters, or they can be fully implanted as ports. Compared with long-term catheters, implanted ports have lower infection rates and improved perceptions of quality of life, but complications still occur in 2% to 18% of patients, frequently requiring removal of the device. Since the conception of implantable vascular access device ports, numerous advances in port design, materials, and techniques for implantation and care have been developed with the goal of overcoming frequent complications. We review the evidence related to these advances and their effect on the safety profile and complications of implantable vascular access device ports.

Cathlink 20: a subcutaneous implanted central venous access device used in children with sickle cell disease on long-term erythrocytapheresis--a report of low complication rates

BACKGROUND

Experience with the use of central venous access device (CVAD) in children with sickle cell disease (SCD) on hypertransfusion is limited and published studies report wide variability in the rates of CVAD-associated complications.

PROCEDURE

In this study, a total of 18 Cathlink 20 ports (Bard Access systems, Salt Lake City, UT) were implanted in 15 patients aged 7-20 years with SCD for 19, 230 catheter patient days.

RESULTS

No peri-operative complications were observed. Three episodes of catheter occlusion requiring replacement occurred in two patients for an observed rate of 0.16 per 1,000 catheter patient days for thrombotic occlusion. One patient required port replacement and another patient required replacement twice. In 13 out of 15 patients, the median duration of port use was 45 months. No episode of catheter-associated bacteremia or catheter tunnel infections was observed.

CONCLUSIONS

Comparing our results with other reported studies of CVAD-associated complications in patients with SCD, we observed a lower rate of complications with the use of Cathlink 20 ports. These findings may be partly related to the design of the port and partly to a dedicated group of nurses accessing the ports in a controlled environment in an apheresis unit.

Long-term therapeutic plasma exchange in the outpatient setting using an implantable central venous access device

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.