Efficacy and safety of femoral vascular access for peripheral blood stem cell (PBSC) collection

Abstract

Summary:Central venous catheters are frequently used in leukapheresis to provide high flow rates. The most common locations are the subclavian or jugular vein, but insertion-related complications and inadequate flow are frequent problems. Experience using femoral venous access is limited, because this has been discouraged due to the high incidence of infectious or thromboembolic complications. We evaluated the safety and efficacy of 108 short-term femoral venous dialysis catheters used for the collection of peripheral blood stem cells (PBSCs). All catheters were placed by a member of the dialysis unit, and they remained in situ for the days needed to reach the target number of CD34 þ cells. No prophylactic antibiotic or antithrombotic therapy was used. A total of 232 apheresis sessions was performed. The longest duration a catheter remained in situ was 5 days. Most of the patients finished the collection in one or two apheresis sessions. There were no thrombotic or infectious complications, and insertion-related complications or mechanical problems were minimal. Apheresis results were similar to those reported using subclavian or jugular venous access. The short-term use of femoral venous dialysis catheters appears safe and effective for PBSC collection, simplifying the procedure, improving patient comfort, and reducing cost.

Performance and safety of femoral central venous catheters in pediatric autologous peripheral blood stem cell collection

“…These results are equivalent or better than those reported in adults (Table ) . Shariatmadar and Noto reported bleeding in 1/63 (1.6%) of autologous adult patients, with no episodes of occlusion or flow‐related AE, even after 6 days .…”

“…Femoral CVC provided adequate venous access with few flow‐related alarms or complications when compared to thoracic CVC in our pediatric population. Our experience with femoral CVC for A‐HPCC is equivalent or better than that reported in adults . Potential disadvantages of femoral CVC are mobility restrictions due to risk of catheter kinking, breaking or disconnection; vessel injury, thrombosis, and infection .…”

“…Shariatmadar and Noto reported bleeding in 1/63 (1.6%) of autologous adult patients, with no episodes of occlusion or flow‐related AE, even after 6 days . In contrast, Moreiras‐Plaza et al encountered catheter‐related flow issues in 12% (29/232) of procedures that were resolved by patient repositioning or reversing lines: other AE included minor bleeding after insertion (2%) and hematoma (15.8%) . A larger study of 147 adults and 488 HPCC reported catheter‐related AE rate in 5% of procedures and 16.8% of patients.…”

Peripheral blood stem cell collection in allogeneic donors: impact of venous access

“…The donors are allowed to stand up and walk 30 minutes after CVC removal, which means there is very little discomfort. The safety of femoral venous access for stem cell collection in patients and also in healthy donors has been well established by other groups 12‐14 . In a large survey on 2408 unrelated donors from the National Marrow Donor Program, Pulsipher and colleagues 5 reported on 253 (10.5%) donors undergoing leukapheresis procedures with a CVC.…”

Mobilized peripheral blood stem cell apheresis via Hickman catheter in pediatric patients

“…Generally, the performance of leukapheresis requires two large‐lumen accesses. In pediatric patients, due to the limited ability to establish large‐bore peripheral venous access, it is common to establish central venous access to provide adequate flow rates . Over one of these lines, blood is diverted from the patient (outlet) into the apheresis device.…”