ABSTRACT
An intravenous plasmapheresis catheter which excludes >99.4% of platelets from external ultrafiltration circuits is currently undergoing safety and efficacy trials for fluid removal from NYHA class II-IV congestive heart failure patients resistant to diuretic drug therapy. In animals, the SCIP catheter allowed a four fold increase in ultrafiltration efficiency without hemolysis, hemoinstability or external cartridge changes in 72 hours of treatment. Further, systemic anticoagulation was not required. These techniques might be envisioned for treatment of fluid overload in heart failure, surgery or trauma and may have applications in therapeutic apheresis, venous thrombosis, liver disease or autologous tissue engineering.
Subject(s)
Blood , Extracorporeal Circulation , Hemofiltration , Plasmapheresis/methods , Animals , Edema/therapy , Feasibility Studies , Heart Failure/therapy , Humans , Time Factors , Wounds and Injuries/therapySubject(s)
Catheterization, Central Venous/instrumentation , Catheters, Indwelling , Hemofiltration/methods , Renal Dialysis/instrumentation , Animals , Catheterization, Central Venous/methods , Cell Separation , Disease Models, Animal , Equipment Design , Equipment Safety , Female , Hemofiltration/instrumentation , In Vitro Techniques , Kidney Failure, Chronic/therapy , Male , Renal Dialysis/methods , Sensitivity and Specificity , SwineABSTRACT
Intermittent dialysis is still the predominant treatment for acute or chronic renal insufficiency in the USA despite increasing evidence that slower and longer fluid management therapies are more beneficial to the patient. We have investigated the use of slow continuous intracorporeal plasmapheresis (SCIP) as a more efficient and hemodynamically stable alternative means of treating acute fluid overload. In this paper we discuss preliminary observations on the safety of SCIP catheter insertion, fluid removal, extraction and pathology in Yorkshire pigs. SCIP catheters removed plasma for extracorporeal plasma water removal without significant gross or histopathological changes. Blood chemistry and cell counts remained stable during therapy. Toxicological studies indicated no pyrogenicity, hemolysis, cytotoxicity, acute systemic toxicity, delayed-type hypersensitivity, or blood recalcification coagulation inhibition. Intracutaneous extracts caused only mild irritation. SCIP therapy appears to be safe for use in the removal of plasma and plasma water from experimental animals.
Subject(s)
Plasmapheresis/methods , Water-Electrolyte Balance , Acute Disease , Animals , Blood Chemical Analysis , Catheterization , Hemofiltration/adverse effects , Hemofiltration/instrumentation , Hemofiltration/methods , Jugular Veins/pathology , Models, Animal , Plasmapheresis/adverse effects , Plasmapheresis/instrumentation , Swine , Vena Cava, Inferior/pathology , Whole Blood Coagulation TimeABSTRACT
Future advances in dialysis of end-stage renal disease patients may include improvements in therapeutic continuity and patient mobility. Continuous renal replacement therapies could lead to self-contained, mobile and potentially wearable dialysis units. We investigated an experimental, intravenous slow-continuous plasma separation system (IPSS) as a precursor to direct intravenous hemofiltration. An intracorporeal catheter employs asymmetric hollow fibers to separate blood cells from plasma in vivo. The fibers possess a sieving coefficient of 0.7 microm and remove 99.99% of all platelets. In vivo, catheters sustain an average plasma separation flow rate of 3 ml/min over 22 h, sufficient to remove 2 net liters of water from pigs through an extracorporeal hemofilter. Used catheter fibers are relatively free of protein deposition or clots in situ. In vitro studies suggest that human catheters may perform at 3-4 times the rate of porcine catheters. IPSS is proposed for acute fluid removal in CHF patients refractory to diuretics.