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Martynov I, Klima-Frysch J, Kluwe W, Engel C, Schoenberger J. Safety of tunneled central venous catheters in pediatric hematopoietic stem cell recipients with severe primary immunodeficiency diseases. PLoS One 2020; 15:e0233016. [PMID: 32413055 PMCID: PMC7228048 DOI: 10.1371/journal.pone.0233016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 04/26/2020] [Indexed: 11/19/2022] Open
Abstract
Tunneled central venous catheters (TCVCs) provide prolonged intravenous access for pediatric patients with severe primary immunodeficiency disease (PID) undergoing hematopoietic stem cell transplantation (HSCT). However, little is known about the epidemiology and clinical significance of TCVC-related morbidity in this particular patient group. We conducted the retrospective analysis of patients with severe PID who received percutaneous landmark-guided TCVC implantation prior to HSCT. We analyzed 92 consecutive TCVC implantations in 69 patients (median [interquartile range] age 3.0 [0-11] years) with severe combined immune deficiency (n = 39, 42.4%), chronic granulomatous disease (n = 17, 18.4%), and other rare PID syndromes (n = 36, 39.2%). The median length of TCVC observation was 144.1 (85.5-194.6) days with a total of 14,040 catheter days at risk (cdr). The overall rate of adverse events during catheter insertion was 17.4% (n = 16) and 25.0% during catheter dwell period (n = 23, catheter risk [CR] per 1000 cdr = 1.64). The most common complication was TCVC-related infection with an overall prevalence of 9.8% (n = 9, CR = 0.64), followed by late dislocation (n = 6, 6.5%, CR = 0.43), early dislocation (n = 4, 4.3%) and catheter dysfunction (n = 4, 4.3%, CR = 0.28). TCVCs are safe in children with severe PID undergoing HSCT with relatively low rates of TCVC-related infection.
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Affiliation(s)
- Illya Martynov
- Department of Pediatric Surgery, University Hospital of Freiburg, Freiburg, Germany
- Department of Pediatric Surgery, University of Leipzig, Leipzig, Germany
- * E-mail:
| | - Jessica Klima-Frysch
- Department of Pediatric Surgery, University Hospital of Freiburg, Freiburg, Germany
| | - Wolfram Kluwe
- Department of Pediatric Surgery, University Hospital of Freiburg, Freiburg, Germany
| | - Christoph Engel
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| | - Joachim Schoenberger
- Department of Pediatric Surgery, University Hospital of Freiburg, Freiburg, Germany
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Doberschuetz N, Soerensen J, Bonig H, Willasch A, Rettinger E, Pfirrmann V, Salzmann-Manrique E, Schäfer R, Klingebiel T, Bader P, Jarisch A. Mobilized peripheral blood stem cell apheresis via Hickman catheter in pediatric patients. Transfusion 2019; 59:1061-1068. [PMID: 30610749 DOI: 10.1111/trf.15113] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 10/24/2018] [Accepted: 10/30/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND Autologous stem cell transplantation remains an integral treatment tool for certain childhood malignancies. In children, a central venous catheter is typically necessary to provide adequate flow rates for preparative apheresis. In this study, the feasibility and efficiency of collecting CD34+ cells via an indwelling Hickman catheter, preimplanted for chemotherapy, instead of placing an additional temporary central venous catheter was evaluated. STUDY DESIGN AND METHODS Forty-eight pediatric leukaphereses for autologous hematopoietic stem cell transplantation using Spectra Optia MNC, Version 3.0 were reviewed. We compared preimplanted Hickman catheters with a temporary Shaldon catheter, inserted for apheresis. Apheresis was considered successful if a dose of 2 × 106 CD34+ peripheral blood stem cells/kg BW was achieved. RESULTS In 43 (89.6%) of the 48 patients, a Hickman catheter was used for leukapheresis. Only 5 patients (10.4%) received a temporary Shaldon catheter. In both groups, apheresis was performed without apparent adverse reactions. The dose of collected CD34+ peripheral blood stem cells was 12.7 × 106 (range, 2.3-70.7 × 106 ) cells/kg BW in the Hickman group and 16.2 × 106 (range, 3.8-48.4 × 106 ) cells/kg BW in the Shaldon group, showing no statistically significant difference (p = 0.58). In both groups, the primary endpoint of a minimal CD34+ cell concentration of 2 × 106 cells/kg BW was achieved at a maximum of two leukapheresis sessions. Apheresis efficacy was further confirmed by the collection efficiency of 40.2% in the Hickman group and 27.8% in the Shaldon group (p = 0.32). CONCLUSION These data indicate the reliable feasibility and efficacy of mobilized apheresis via an indwelling Hickman catheter. In light of this, the routine insertion of a dialysis catheter for the purpose of leukapheresis should be critically reconsidered.
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Affiliation(s)
- Nora Doberschuetz
- Department for Children and Adolescents, Division for Pediatric Stem Cell Transplantation and Immunology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Jan Soerensen
- Department for Children and Adolescents, Division for Pediatric Stem Cell Transplantation and Immunology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Halvard Bonig
- Institute for Transfusion Medicine and Immunohematology, Goethe University, Frankfurt, Germany.,Department for Cellular Therapeutics, German Red Cross Blood Service Baden-Württemberg-Hesse, Frankfurt am Main, Germany
| | - Andre Willasch
- Department for Children and Adolescents, Division for Pediatric Stem Cell Transplantation and Immunology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Eva Rettinger
- Department for Children and Adolescents, Division for Pediatric Stem Cell Transplantation and Immunology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Verena Pfirrmann
- Department for Children and Adolescents, Division for Pediatric Stem Cell Transplantation and Immunology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Emilia Salzmann-Manrique
- Department for Children and Adolescents, Division for Pediatric Stem Cell Transplantation and Immunology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Richard Schäfer
- Department for Cellular Therapeutics, German Red Cross Blood Service Baden-Württemberg-Hesse, Frankfurt am Main, Germany
| | - Thomas Klingebiel
- Department for Children and Adolescents, Division for Pediatric Stem Cell Transplantation and Immunology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Peter Bader
- Department for Children and Adolescents, Division for Pediatric Stem Cell Transplantation and Immunology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Andrea Jarisch
- Department for Children and Adolescents, Division for Pediatric Stem Cell Transplantation and Immunology, University Hospital Frankfurt, Frankfurt am Main, Germany
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Barretta LM, Beccaria LM, Cesarino CB, Pinto MH. Complications of central venous catheter in patients transplanted with hematopoietic stem cells in a specialized service. Rev Lat Am Enfermagem 2017; 24:S0104-11692016000100331. [PMID: 27276021 PMCID: PMC4915799 DOI: 10.1590/1518-8345.0547.2698] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 08/07/2015] [Indexed: 11/28/2022] Open
Abstract
Objective: to identify the model, average length of stay on site and complications of central
venous catheter in patients undergoing transplant of hematopoietic stem cells and
verify the corresponding relationship between the variables: age, gender, medical
diagnosis, type of transplant, implanted catheter and insertion site. Method: a retrospective and quantitative study with a sample of 188 patients transplanted
records between 2007 and 2011. Results: the majority of patients used Hickman catheter with an average length of stay on
site of 47.6 days. The complication fever/bacteremia was significant in young
males with non-Hodgkin's lymphoma undergoing autologous transplant, which remained
with the device for a long period in the subclavian vein. Conclusion: nurses should plan with their team the minimum waiting time, recommended between
the catheter insertion and start of the conditioning regimen, as well as not to
extend the length of time that catheter should be on site and undertake their
continuing education, focusing on the prevention of complications.
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Affiliation(s)
- Lidiane Miotto Barretta
- RN, Centro de Educação Permanente, FUNFARME, São José do Rio Preto, SP, Brazil., Centro de Educação Permanente, FUNFARME, São José do Rio Preto SP , Brazil
| | - Lúcia Marinilza Beccaria
- Adjunct Professor, Departamento de Enfermagem Geral, Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, SP, Brazil., Faculdade de Medicina de São José do Rio Preto, Departamento de Enfermagem Geral, Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto SP , Brazil
| | - Cláudia Bernardi Cesarino
- Adjunct Professor, Departamento de Enfermagem Geral, Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, SP, Brazil., Faculdade de Medicina de São José do Rio Preto, Departamento de Enfermagem Geral, Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto SP , Brazil
| | - Maria Helena Pinto
- Professor, Departamento de Enfermagem Geral, Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, SP, Brazil., Faculdade de Medicina de São José do Rio Preto, Departamento de Enfermagem Geral, Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto SP , Brazil
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Reich-Slotky R, Cushing MM, Hsu YMS, Ancharski M, Rojas JM, Scrimenti LM, Robilio S, Assalone D, Roselli T, Guarneri D, Vasovic LV, Goel R, Shore T, van Besien K. Validating and implementing the use of an infusion pump for the administration of thawed hematopoietic progenitor cells-a single-institution experience. Transfusion 2017; 58:339-344. [PMID: 29193156 DOI: 10.1111/trf.14409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 09/30/2017] [Accepted: 10/05/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Direct thaw and administration of previously cryopreserved peripheral blood stem cell products is a commonly used practice and should be performed rapidly to reduce cellular damage caused by dimethyl sulfoxide exposure. Cells are typically thawed at the bedside and infused by gravity through a high-flow-rate central venous catheter. An existing nontunneled catheter is occasionally used instead and often results in a slower infusion rate. To ensure expedient and consistent infusions, we validated and implemented the use of an infusion pump for thawed peripheral blood stem cells. STUDY DESIGN AND METHODS Validation was performed in two phases: in vitro simulation and in vivo clinical assessment. Total nucleated cell recovery and viability plus progenitor cell viability and potency were compared in vitro between two cryopreserved peripheral blood stem cell units that were either passed through a preset infusion pump or drained by gravity. The infusion rate, adverse events, and engraftment times were retrospectively compared between patients who received infusions by infusion pump (n = 35) and by gravity (n = 38). RESULTS No significant differences were observed in vitro between the infusion methods for all measured variables. Overall infusion rates were similar in vivo for both groups but were significantly lower for patients who had nontunneled catheters that delivered the infusion by gravity. The time to neutrophil and platelet engraftment was similar for both groups. CONCLUSION This is the first study to assess the use of an infusion pump for stem cell transplant. The use of an infusion pump for peripheral blood stem cell infusion is safe, provides a reliable and consistent infusion method, and can mitigate the effect of the type of venous access line used.
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Affiliation(s)
- Ronit Reich-Slotky
- Department of Transfusion Medicine and Cellular Therapy, New York Presbyterian Hospital/Weill Cornell Medical Center
| | | | | | - Michael Ancharski
- Department of Transfusion Medicine and Cellular Therapy, New York Presbyterian Hospital/Weill Cornell Medical Center
| | - Johanna M Rojas
- Department of Transfusion Medicine and Cellular Therapy, New York Presbyterian Hospital/Weill Cornell Medical Center
| | - Lara M Scrimenti
- Department of Nursing, Inpatient Bone Marrow Transplant, New York Presbyterian Hospital/Weill Cornell Medical Center
| | - Shawna Robilio
- Department of Nursing, Inpatient Bone Marrow Transplant, New York Presbyterian Hospital/Weill Cornell Medical Center
| | - Dianna Assalone
- Department of Nursing, Inpatient Bone Marrow Transplant, New York Presbyterian Hospital/Weill Cornell Medical Center
| | - Therese Roselli
- Department of Nursing, Inpatient Bone Marrow Transplant, New York Presbyterian Hospital/Weill Cornell Medical Center
| | | | | | - Ruchika Goel
- Department of Pathology, Weill Cornell Medical College.,Department of Pediatrics, Division of Pediatric Hematology Oncology, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
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Cooling L, Hoffmann S, Webb D, Yamada C, Davenport R, Choi SW. Performance and safety of femoral central venous catheters in pediatric autologous peripheral blood stem cell collection. J Clin Apher 2017; 32:501-516. [PMID: 28485045 DOI: 10.1002/jca.21548] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Revised: 03/08/2017] [Accepted: 04/04/2017] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Autologous peripheral blood hematopoietic progenitor cell collection (A-HPCC) in children typically requires placement of a central venous catheter (CVC) for venous access. There is scant published data regarding the performance and safety of femoral CVCs in pediatric A-HPCC. METHODS Seven-year, retrospective study of A-HPCC in pediatric patients collected between 2009 and January 2017. Inclusion criteria were an age ≤ 21 years and A-HPCC using a femoral CVC for venous access. Femoral CVC performance was examined by CD34 collection rate, inlet rate, collection efficiency (MNC-FE, CD34-FE), bleeding, flow-related adverse events (AE), CVC removal, and product sterility testing. Statistical analysis and graphing were performed with commercial software. RESULTS A total of 75/119 (63%) pediatric patients (median age 3 years) met study criteria. Only 16% of children required a CVC for ≥ 3 days. The CD34 collect rate and CD34-FE was stable over time whereas MNC-FE decreased after day 4 in 80% of patients. CD34-FE and MNC-FE showed inter- and intra-patient variability over time and appeared sensitive to plerixafor administration. Femoral CVC showed fewer flow-related AE compared to thoracic CVC, especially in pediatric patients (6.7% vs. 37%, P = 0.0005; OR = 0.12 (95%CI: 0.03-0.45). CVC removal was uneventful in 73/75 (97%) patients with hemostasis achieved after 20-30 min of pressure. In a 10-year period, there were no instances of product contamination associated with femoral CVC colonization. CONCLUSION Femoral CVC are safe and effective for A-HPCC in young pediatric patients. Femoral CVC performance was maintained over several days with few flow-related alarms when compared to thoracic CVCs.
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Affiliation(s)
- Laura Cooling
- Department of Pathology, Blood and Marrow Transplantation Program, University of Michigan, Ann Arbor, Michigan
| | - Sandra Hoffmann
- Department of Pathology, Blood and Marrow Transplantation Program, University of Michigan, Ann Arbor, Michigan
| | - Dawn Webb
- Department of Pathology, Blood and Marrow Transplantation Program, University of Michigan, Ann Arbor, Michigan
| | - Chisa Yamada
- Department of Pathology, Blood and Marrow Transplantation Program, University of Michigan, Ann Arbor, Michigan
| | - Robertson Davenport
- Department of Pathology, Blood and Marrow Transplantation Program, University of Michigan, Ann Arbor, Michigan
| | - Sung Won Choi
- Department of Pediatric, Blood and Marrow Transplantation Program, University of Michigan, Ann Arbor, Michigan
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Factors influencing catheter-related infections in the Dutch multicenter study on high-dose chemotherapy followed by peripheral SCT in high-risk breast cancer patients. Bone Marrow Transplant 2008; 42:475-81. [DOI: 10.1038/bmt.2008.195] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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7
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Carausu L, Clapisson G, Philip I, Sebban H, Marec-Bérard P. Use of totally implantable catheters for peripheral blood stem cell apheresis. Bone Marrow Transplant 2007; 40:417-22. [PMID: 17603515 DOI: 10.1038/sj.bmt.1705756] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Collection of PBSC by leukapheresis requires one venous access (VA) for inflow and one for outflow. The use of implantable venous access devices (IVAD) has never been reported in this setting. We retrospectively analyzed the use of IVAD for performing apheresis. The study was conducted between January 2000 and June 2005 on 64 patients (41 children) requiring intensification for treatment of a solid tumor. Mean body weight was 26 kg (range 8-91 kg) for a median age of 8.5 years (range 0.7-66 years). A total of 121 aphereses were performed (mean 1.89 apheresis/patient). The second VA was in a cubital vein in 84 procedures and was a temporary central VA in 31. Mean duration of apheresis was 3 h (range 30-274 min). Mean flow rate was 41.3 ml/min (range 12-85 ml/min). Mean collection rate was 59.2% for CD34+ cells and 70% for mononuclear cells. The total number of CD34+ cells collected was 2.5 x 10(6)/kg per apheresis, and 5.9 x 10(6)/kg per patient. Several complications occurred: one catheter-related sepsis (0.86%), four catheter occlusions (3.47%) and eight hemodynamic instabilities related to extracorporeal volume. Weight <10 kg is a risk factor for complication (P=0.0006). IVAD are effective and safe for PBSC collection. Placement of a second central VA (requiring general anesthesia for children) could be avoided.
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Affiliation(s)
- L Carausu
- Pediatric Oncology Unit, Centre Léon-Bérard, Lyon, France
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8
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Conter C, Carausu L, Martin E, Rubie H, Castex MP, Marec-Berard P. Utilisation des sites veineux implantables dans les chimiothérapies massives en pédiatrie. Arch Pediatr 2006; 13:256-61. [PMID: 16469486 DOI: 10.1016/j.arcped.2005.12.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2005] [Accepted: 12/16/2005] [Indexed: 11/23/2022]
Abstract
BACKGROUND The feasibility and complication rate of central venous totally implantable access ports (TIAP), used for delivering high-dose chemotherapy (HDC) with autologous stem cell transplantation, have not been fully investigated to date, due to the almost exclusive use of external catheters (EC) in this clinical setting. PATIENTS AND METHODS We retrospectively studied infectious and mechanical complications of 45 TIAP and 19 EC, in 64 children receiving HDC and autologous stem cell transplantation at the Centre Leon-Berard (Lyon) or at the oncology unit of Toulouse children hospital between January 1999 and December 2003. RESULTS From the beginning of intensification to 60 days after bone marrow transplantation, 7 catheter-related bloodstream infections (3/19 EC or 15.8% corresponding to 2.69 infections for 1000 days of observation; 4/45 TIAP or 8.9% corresponding to 1.38 infections for 1000 days of observation) and 2 local infections (1/45 TIAP; 1/19 EC) were reported. Seven cases of reversible obstruction (6/7 with TIAP) and no deep venous thrombosis were detected. In 7 cases, another venous access was required either for accidental removal (2 EC), catheter infection (2 TIAP), or admission to intensive care (2 TIAP, 1 EC). TIAP complication rate does not seem to be influenced by factors such as low weight, massive blood product transfusion or prolonged parenteral nutrition. In 8 children, TIAP were used for collection of hematopoietic progenitor cells. CONCLUSIONS The use of TIAPs appears as a safe and effective option for HDC. We found more mechanical complications but less infectious complications with TIAP than with EC. Nevertheless, results need to be validated prospectively in a larger study cohort.
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Affiliation(s)
- C Conter
- Centre Léon-Bérard, 28, rue Laennec, 69008 Lyon, France.
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Sauer-Heilborn A, Kadidlo D, McCullough J. Patient care during infusion of hematopoietic progenitor cells. Transfusion 2004; 44:907-16. [PMID: 15157259 DOI: 10.1111/j.1537-2995.2004.03230.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Annette Sauer-Heilborn
- Division of Transfusion Medicine, Department of Laboratory Medicine and Pathology, University of Minnesota Medical School, Minneapolis, Minnesota 55455, USA
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Restrepo A, Devore P, Encarnación CE, Wholey MH, Schneider D, Callander NS, Ferral H, Postoak D, Anderson JE, Walsh T, Padayao G, Gokmen E, Ehsan A, Ochoa L, Neumon B, West G, Restrepo MI, Przykucki J, Patterson J, Freytes CO. Performance of a hybrid central venous catheter utilized for both peripheral blood stem cell harvest and transplant support of patients undergoing autologous peripheral blood stem cell transplantation. Bone Marrow Transplant 2002; 30:389-95. [PMID: 12235524 DOI: 10.1038/sj.bmt.1703647] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2002] [Accepted: 04/22/2002] [Indexed: 11/09/2022]
Abstract
Patients undergoing autologous peripheral blood stem cell transplantation (PBSC) frequently require the sequential insertion of two central venous catheters, one for leukapheresis and one for transplant support. Hybrid catheters suitable for leukapheresis and long-term use have been increasingly used, but there is limited information regarding their performance and complication rate. The purpose of this study was to determine the performance of the Pheres-Flow hybrid catheter when utilized for both leukapheresis and transplant support, with particular emphasis on the incidence of infectious and occlusive complications. We prospectively analyzed the performance of 92 catheters in 82 consecutive patients who underwent autologous peripheral blood stem cell (PBSC) transplantation. Occlusion was the most frequent complication of this catheter with 29% of the patients experiencing difficulty drawing blood or infusing fluids. Infection was another frequent complication. Twenty-two percent of patients developed catheter-related bloodstream infections and 15 catheters had to be removed because of proven or suspected infection that did not respond to antibiotic therapy. Nevertheless, 77% of patients were able to complete leukapheresis and transplant support with only one catheter. We conclude that the utilization of the Pheres-Flow catheter for both leukapheresis and transplant support is feasible, but that new strategies need to be developed to decrease the incidence of occlusive and infectious complications of hybrid catheters.
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Affiliation(s)
- A Restrepo
- Department of Medicine, University of Texas Health Science Center, San Antonio, USA
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Fischmeister G, Witt V, Zaunschirm HA, Fritsch G, Höcker P, Pötschger U, Zoubek A, Gadner H. Permanent tunneled silicone central venous catheters for autologous PBPC harvest in children and young adults. Bone Marrow Transplant 2000; 26:781-6. [PMID: 11042661 DOI: 10.1038/sj.bmt.1702587] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Children with high risk malignancies are usually given permanent (Hickman-type) tunneled silicone rubber central venous catheters (silicone CVCs) for the administration of chemotherapy. In the past, these children received an additional short-term polyurethane dialysis CVC for stem cell apheresis. To avoid placement of an additional short-term CVC, we started in 1995 to use pre-existing silicone CVCs for PBPC harvests. From May 1996 to February 1999 we evaluated 165 harvests in 37 children and 14 young adults (16-28 years) treated with high-dose chemotherapy and stem cell support, comparing CD34+ cell harvest efficiency, catheter tolerability, and complications in three different approaches to vascular access. Pre-existing silicone CVCs (64%) or peripheral venous cannulae (15%) were the first choice for venous access. Only when these failed were polyurethane CVCs (21%) used. No significant difference was seen between these three groups, even after dividing the silicone CVC group (105 harvests in 32 patients) into three subgroups according to weight and age. The most frequent problems were citrate toxicity (n = 33), mechanical obstruction inside (n = 9) and outside the cell separator (n = 2), decreased draw line flow in silicone CVCs (n = 7), decreased draw line flow in peripheral venous cannulae (n = 6), and one occlusion in a polyurethane CVC. Pre-existing CVCs and peripheral venous cannulae functioned efficiently when used as a draw line in 79% of the apheresis procedures without significantly reducing single harvest efficiency or catheter tolerability. Consequently, the risks and costs associated with the placement of a dialysis CVC could be avoided in the majority of cases. Bone Marrow Transplantation (2000) 26, 781-786.
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Affiliation(s)
- G Fischmeister
- St Anna Children's Hospital and Children's Cancer Research Institute, Vienna, Austria
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