Reply To: plasma exchange

I had plasma exchange after two five-day rounds of IvIg failed to arrest the progress of loss of strength. My neurologist was wanting to do it after the first round, but decided to do a second round as a more conservative approach which sometimes works (it didn’t). A week or so after my second round of IvIg I crashed and ended up in the ICU to get plasma exchange. I was apprehensive about the procedure, but by that time my reservations didn’t matter. The PE doctor offered to explain it, but I told him to explain it to my daughter — I don’t like to hear too much about medical procedures.

I had a Quinton catheter put in my leg for access. Sometimes a catheter is put in the neck instead. This is the worst part of the whole procedure, but as it turned out in my case, the apprehension was everything. The catheter was put in under heavy sedation. I have no recollection of its being installed. I was groggy for awhile coming out of it, but experienced no pain whatsoever during or after the procedure. According to my daughter, I said some strange things under sedation, so you might want to consider that possibility.

I had nine PE treatments. They were all completely painless and I had no other side effects. Most of them I slept through. I was in such bad shape when they were started that I don’t recall much during the time I was awake. By the last couple of treatments my recovery had started. I went off pain meds somewhere in the middle of the PE treatments and was feeling much better, so I was able to watch the whole procedure. It was definitely disconcerting to see my blood being pumped out in such a large quantity (about 10% I think), but everything went smoothly. My catheter never got infected, which is one of the main concerns.

When the catheter is removed, no anesthetic is required. A nurse just pulls it out. She told me to do some breathing thing as a distraction, but there was absolutely no pain associated with removing it. Then she put on a pressure dressing, which takes a few minutes because she must apply pressure until the wound starts to heal. Then there’s a critical time for an hour or two to make sure the dressing isn’t leaking, so it’s necessary to be awake and able to call for help if necessary (it wasn’t). The nurse showed me the catheter. She didn’t need to do that. It was a lot bigger than I expected!

It’s impossible not to worry about it at first, but if your doctor wants it, go for it, because this is something that can work well. My condition turned around during PE, and by the time I finished the treatments I was off pain and anxiety meds and feeling good. Take sedation when the port is installed, but you don’t need anything when they hook up to the port and do their thing. There’s nothing to it. It’s good for you.

By the way, my description is of an in-hospital procedure. If you are not in a hospital, you may be having an outpatient procedure. The port would be different and I don’t know anything about that. It can only be easier than what I had, I expect. Good luck!