Side-effects and complications in large-bore catheters for apheresis.

Vascular catheters have become essential tools for management of hospitalized or chronically ill patients requiring intensive medical treatments such as extracorporeal detoxification procedures. The increased use of such devices has been accompanied by a corresponding increase in complications, such as bloodstream infection and thrombosis. In a retrospective study 332 large bore catheters which were inserted in 182 patients in the inferior or superior vena cava were investigated. The complication rate was in internal jugular vein puncture (N = 231) with 20% low and in the subclavian vein puncture (N = 94) with 60.5% and in the femoral vein puncture (N = 7) with 57.1% very high. The majority of complications were puncture not possible, puncture of the artery, abscess, septicemia, bleeding and thrombosis. To minimize the complication rate the surface of some catheters were treated and the microdomain structured surface inserted. The first results are very encouraging and should help to make large bore catheters safer.

Changes in lymphocytic cluster distribution during extracorporeal immunoadsorption.

The success of apheresis treatment is often measured as a decrease in the detected antibodies and an improvement in different disease-related scores. Sometimes, however, the seriousness of the disease does not correlate with the antibody level. During a period of 8 years, 15 patients (3 myasthenia gravis, 1 multiple sclerosis, 2 systemic lupus erythematosus, 3 alloimmunized kidney transplant, 6 rheumatoid arthritis) were treated by protein A immunoadsorption. Lymphocyte subpopulations (activated T cells, cytolytic T cells, B cells, natural killer cells) and inflammatory proteins (ferritin, C-reactive protein, alpha1-antitrypsin, alpha2-macroglobulin) were analyzed. After observing clinical outcomes, the patients could be divided into 2 groups, respectively: Group 1, responding patients with remission of disease; and Group 2, delayed-responding patients, who required chronic treatment. Group 1 patients characteristically showed a greater increase in activated T and cytolytic T cells which correlated with a greater decrease of B cells. It might be possible that protein A immunoadsorption induced immunomodulation. Further immunological investigation is required to verify these findings.