Infective complications of plasma exchange: a prospective study

We examined the incidence and types of infective complications which occurred in 41 patients whose medical management included plasma exchange (PX) by intermittent cannulation; femoral, subclavian, or internal jugular catheter; or arteriovenous shunt. A high incidence of positive cultures from vascular access catheters was demonstrated. Of 23 patients for whom data were available, 13 had positive cultures, and results on 3 of these showed greater than 1 species. Gram-positive cocci were typically found. Of the 34 patients who received drug immunosuppression with PX, 1 patient developed severe shunt-site infection, and an additional 4 developed bacteremia. Seven patients were given PX alone, and none of these developed clinically significant infection; however, this difference in infection rate did not reach statistical significance. Clinically significant access-related infection remains an infrequent but potentially important hazard of therapeutic PX.