Nationwide practices in the use of central venous catheters for therapeutic plasma exchange in the inpatient setting

Abstract

Introduction: Therapeutic plasma exchange (TPE) is often impacted by difficulties in obtaining an adequate and safe vascular access. This study evaluated the rates, predictive factors, and clinical outcomes associated with central venous catheter (CVC) use during the inpatient TPE procedures. Methods:The Nationwide Readmissions Database, 2016 to 2017 was used to identify hospitalizations with TPE with and without CVC insertion. Results: During the study period, there were 35 429 hospitalizations with TPE (pediatric 6.1%, mean ± standard deviation (SD) age 50.9 ± 20.0 years, female 52.7%). CVC insertion was documented in 24 414 (73.4%) adult and 1596 (73.5%) pediatric hospitalizations. In pediatric patients, age >15 years, higher disease severity, and private insurance were associated with higher odds of CVC insertion. In adults, female sex, obesity, concurrent hemodialysis, and higher disease severity were associated with CVC insertion. Adults with private insurance and both adult and pediatric hospitalizations at the teaching hospitals had lower odds of CVC placement. All patients with CVC insertion had longer length of hospital stay, and adults with CVC insertion also had higher hospital charges, higher in-hospital mortality, and lower likelihood of being discharged to home. Conclusion: CVC insertion is performed for the majority of inpatient TPE procedures and CVC use appears to correlate with worse clinical outcomes.

Central venous catheters are associated with thrombosis among adult inpatients undergoing therapeutic plasma exchange

“…Our finding of a high prevalence of CVC use is consistent with data showing that CVCs are the most commonly used venous access type for TPE in the US 1,3,40 . A Nationwide Readmissions Database study of CVC use in TPE showed higher rates of CVC use among adults (73%) and children (74%) 3 .…”

“…A national survey of apheresis providers in the American Society for Apheresis (ASFA) showed that CVCs are the preferred method for vascular access for therapeutic apheresis procedures 40 . In a nationwide study of TPE, predictors of CVC use were obesity (18% vs. 16%, P = 0.017), concurrent hemodialysis (14% vs. 10%, P < 0.001), female sex (54% vs. 50%, and illness severity ( P < 0.001) 3 . CVC has been preferred over peripheral venous access due to access difficulties, longer procedural times, suboptimal blood flow, inadequate process volume, and decreased efficiency 2,7,40‐42 .…”

“…Central venous catheters (CVC) are the most often used venous access type in >70% of patients undergoing therapeutic apheresis procedures in the United States (US) 1‐3 . Although CVC is preferred in North and Central America, the dominant mode of access in Europe and Australia is peripheral venous access 4‐6 .…”

Hemostatic effects of therapeutic plasma exchange: A concise review

“…38 However, depending on the region studied, there is a wide range in the prevalence of CVC use (25%-73%). 38,39 Bleeding complications associated with CVC use are noted in a number of studies. In a study of 381 TPE procedures in 63 patients, severe complications occurred in four patients with CVC (6%).…”

“…In an International Apheresis Registry report, central venous catheter (CVC) was the primary access method for TPE procedures in North and Central/South America (90% and 87%, respectively) 38 . However, depending on the region studied, there is a wide range in the prevalence of CVC use (25%‐73%) 38,39 …”