Plasmapheresis catheter and IVIg
AnonymousJuly 20, 2006 at 12:34 am
These questions are mostly for anybody who has a central line catheter used for plasmapheresis. If you have specific material or physiological knowledge, feel free to chime in.
I have a central line, but the plasma exchange is not giving the results we had hoped for. We are going to switch to IVIg. I had hoped to use the catheter as the venous access, as I have particularly horrible access, but the infusion center said they will not do so.
Has anybody use their central line catheter for infusions of any sort? What material or physiological issues would prevent the used of the catheter for infusion of IVIg?
Thanks in advance for your input.
AnonymousJuly 23, 2006 at 11:00 am
When I first got sick & was dx with GBS in April of 2002 I was given 5 plasma pheresis via insertion of a catheter in the groin area? I remember I could not sit up at all for a week. Then I continued to deteriorate & I was given IVIG & steroids via IVs in my arms; soon I ran out of veins & they put a PICC line in my arm, which lasted from June 2002-November 2002.
When they wanted to try PP again, I had surgery & had an ash split catheter inserted into my chest with two pigtails coming out of my right breast. I was then given 3 months of PP, IVIG & then steroids every Friday, using the catheter for all 3. This treatment did nothing for me. It was then decided I needed cytoxan infusions, & I was given 9 months of chemo & weekly solumedrol via this same catheter. I would have this in for 15 months, until I was off of all treatments. Why can’t they use your central line for IVIG?
AnonymousJuly 23, 2006 at 1:19 pm
I don’t really understand why they won’t use the central line for IVIG. My daughter has a Broviac catheder in her chest that she gets IVIG twice weekly in.
Maybe you can’t use the same central line for plasmapheresis then IVIG for some reason. I’d talk with your doctor about this. The reason people get the catheders in the first place is so they don’t have to get continual IV’s placed.
AnonymousJuly 23, 2006 at 9:10 pm
In 2004 I began PP for my CIDP. Initially I had to have a catheter placed in my juggler vein each time I had a two week series. Then in Feb. of 2005, I began a maintenance treatment and to have the tunneled catheter put in my chest. Although it seemd that the PP slowed down the advancement of symptoms, I did not get any better. In July of 2005, I asked to be put on Rituxan and supposed that they would use the chest catheter. I, too, was told that it could not be used and received the Rituxan treatment through arm vein infusions. However, I wasn’t told the reasons. Perhaps it’s because the PP requires two ports???
July 24, 2006 at 7:26 pm
For IVIG I had an infusion port placed beneath the skin on my left chest. Worked really well with little or no risk of infection. When I had to quit IVIG I had an “Ash split catheter” in my right side jugular. Worked well for PP but it was the point of invasion for a staph infection which in less than 72 hours so fired up my cidp that I was in the ICU on a ventelator in critical condition. Now after 8 weeks in the hospital this hiking climbing guy of 2 months ago is home and riding in a wheel chair. For PP the folk here recommend a fistula which gives good access and little chance of infection.
If you are going PP have a surgeon build you a fistula. Use a quenten (sp?) catheter which is pulled after each set of PP until the fistula matures.
AnonymousJuly 25, 2006 at 8:31 pm
Thanks to you all for your replies. I also asked Bard Access, the manufacturer of my catheter (a HemoSplit). The respondent in effect said there was no technical reason why it could not be done, with the typical caveats any device manufacturer must give.
I think Flower is probably right in that it could be a state regulation. One thing I have come to realize is that there as many (more actually) types of nurses as there are types of doctors (13 officially recognized doctor categories), so there is plenty of room for territorial disputes. Or, it may simply be hospital policy. Regardless, the IV was easy enough this time. If the IVIg works well, then I’ll get a subclavian port.
By the way, I have had my catheter for seven months with no infection. Because of allergies to the adhesive typically used in the transparent dressing, I am using gauze dressings. As I result, my site is examined 3 to 4 times a week. With grace, I will catch any infection early. A fistula is probably in my future, but my veins are small enough that a fistula may not give access for too very long.
AnonymousJuly 25, 2006 at 8:38 pm
MarkEns re: adhesive allergies…
My daugher is allergic to the clear plastic bandages as well, they are called Tegaderms. We found that she can use a bandage called Primpora. They are supposed to be the best for sensitive skin. We also put a skin protectant on before using the bandages or any tape. We have to use paper tape as well because of the skin reactions.
After about 2 weeks with a catheter you don’t really have to keep in bandaged. Just tape the line down so it kind of circles around the site & clean it daily. That’s what we do anyways & so far, so good!
AnonymousJuly 25, 2006 at 9:01 pm
Thanks for the input on the Primpora, I’ll look into it.
As far as the need for a dressing goes, you are right that after a certain time, it may not be necessary. However, my medical plan’s policy is that all transdermal materials must be dressed. It is unlikely that I will get that policy overturned.
Fortunately, my wife does all but one of the dressing changes each week, so I don’t spend too much time at the hospital.
AnonymousJuly 26, 2006 at 10:56 pm
I tried an internet search for Primpora, and found it to be a city in Kashmir. However, I did find a dressing called Primapore. It is an absorbent pad dressing, with a nonwoven backing coated with an acrylic adhesive. Is this the dressing you meant? If so, my guess is that the adhesive is the same or very similar to that used on Opsite (several variations to the name), which is a transparent, semi-permeable membrane. I have tried Opsite, without too much success.
Thanks for the suggestion, though.
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