A single, double lumen high-flow catheter for patients undergoing peripheral blood stem cell transplantation. Experience at the National Cancer Institute in Mexico

Abstract

Summary:fusion of PBSC and the i. -106). The incidence of infectiousWe present our experience at the Instituto Nacional de Cancerología in Mexico, with the installation and care of complications was 2.2 ؋ 1000 catheter-days (1.7 Permacath and 3.0 Mahurkar); during neutropenia it was an IVTT including apheresis collection, reinfusion of PBSC and intravenous and hematological support of patients 3.7 ؋ 1000 cathether-days. The incidence of thrombosis was 0.9 ؋ 1000 catheter-days. There was a total of seven undergoing PBSCT in whom a high-flow catheter (Mahurkar or Permacath) was installed between November infectious episodes (12.7%). Five (9%) were local and two were (3.6%) bacteremias. The microorganism most 1992 and June 1994. commonly isolated was Staphylococcus sp. (57%). Four catheters (7.1%) were removed because of complications: one thrombosis and three infections. Both cathMaterials and methods eters have proven useful and safe for long-lasting vascular access in patients undergoing PBSCT. No statistical Catheter difference was found in infectious and non-infectiousThe devices utilized were either a Mahurkar (Quinton complications between either catheters.Instrument, Seattle, WA, USA) double lumen nontunneled Keywords: peripheral blood stem cell transplantation; siliconized catheter or a Permacath (Quinton Instrument) apheresis catheters; intravenous therapy team silastic, double lumen, Dacron felt cuff tunneled catheter. Both catheters are imported to Mexico, and the choice of which one to place in a patient was based solely on availPeripheral blood stem cell transplantation (PBSCT) is a ability. new therapeutic approach for supporting treatment with high-dose chemotherapy.

Multi-purpose silastic dual-lumen central venous catheters for both collection and transplantation of hematopoietic progenitor cells

“…Finally, for six large reports in which central venous catheters were used for 1-533 days during transplantation, bloodstream infections ranged from 4 to 39%. 42,[52][53][54][55][56] In our study and in the published literature, the majority of the organisms recovered were skin commensals. Recent studies have reported reduction of infection in patients undergoing conventional chemotherapy with non-tunneled antiseptic-impregnated or antibiotic-coated catheters.…”

“…[36][37][38][39][40][41] PBPC collection requires the use of high-flow catheter for adequate cell collection through apheresis, and supportive care needs may be extensive. 42 To execute the subsequent transplant, in addition, requires a conventional central venous catheter. Hence, these requirements usually are achieved by insertion of two separate catheters.…”

“…Despite the large catheter size, these results are similar to published reports in hematopoietic stem cell transplant patients with central venous catheters used for pheresis, transplant, or both (Table 4). [38][39][40]42,[43][44][45][46][47][48][49][50][51][52][53][54][55][56] For patients treated using conventional chemotherapy regimens in which catheter duration extended from 1 to 1715 days, bacteremias ranged from 5 to 22%. [43][44][45][46][47][48] For six series disseminated infection experiences during pheresis (with or without hematopoietic stem cell transplantation) ranged from 2 to 9%.…”

Patient care during infusion of hematopoietic progenitor cells

“…In 32 of 112 (29%) catheter dysfunction occurred, and in 7 of 112 (6.3%) catheters were removed because of infection or mechanical problems. Other authors report a similar complication rate in patients using a single double‐lumen catheter for apheresis and PBPC transplantation: 41 In 7.1 percent the catheter was removed because of thrombosis or infection, and in 32 percent dysfunction occurred. Both authors concluded that the use of one catheter for PBPC collection and transplantation should be considered because complication rates are similar to the rates reported in the literature using one central venous catheter line for the transplantation only.…”

Validating and implementing the use of an infusion pump for the administration of thawed hematopoietic progenitor cells—a single‐institution experience

“…To ensure a fast infusion rate, cryopreserved products preferably should be infused using central venous lines. New hybrid, double‐lumen, large‐bore, flexible, long‐term catheters can accommodate both PBSC apheresis collection and transplant . Although long‐term, flexible, multiple‐lumen, tunneled central catheters are preferred, very often, an existing short‐term, nontunneled catheter is used instead.…”