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. J. Clin. Apheresis 17:1–6, 2002.