Non-tunneled catheters for the collection and transplantation of peripheral blood stem cells in children

Abstract

Summary:patients, vascular access problems and low volume of blood are important factors. 7 The collection of PBSC requires venous access which We analyzed the use of non-tunneled (polyurethane, double lumen) central venous catheters (CVCs) for the ensures withdrawal and reinfusion of blood at high flow rates and allows repeated leukapheresis. Here, we analyze our experience of collection procedures following administration of granulocyte colonystimulating factor (G-CSF) using a continuous flow performed with non-tunneled catheters in pediatric patients. These catheters were used for collection, during conditionblood cell separator (Cobe Spectra). The mean TBV (total blood volume) processed was 4.5 ؎ 1. We reviewed 56 pediatric patients (36 males and 20 s.d. × 10 6 /kg (range 1-42), respectively. We observed the females) with various malignancies undergoing 71 leukafollowing complications during catheter insertion for pheresis sessions, from November 1993 until May 1996. collection: pneumothorax (1.7%), mechanical dysfunc-The mean age was 7.8 Ϯ 4.4 s.d. years (range 1-16) and tion (3.5%) that resolved with thrombolytic therapy.the mean body weight 30.7 Ϯ 15.7 s.d. kg (range 9-62). Complications during conditioning, transplantation andPatients had the following diagnoses: nine acute lymphoblimmediate post-transplantation periods were entry site astic leukemia (ALL), five acute non-lymphoblastic leukeinfection in five patients (8.92%), catheter-related infecmia (ANLL), six non-Hodgkin's lymphoma (NHL), three tion in two (3.57%) and catheter-related sepsis in three Hodgkin's disease (HD), 10 rhabdomyosarcoma, seven (5.35%). Our results indicate that the collection of neuroblastoma, five Ewing's sarcoma, one Wilm's tumor PBSC with non-tunneled catheters is safe, effective and and 10 central nervous system tumors. Parents and patients is associated with a low incidence of complications.were provided with information concerning the procedure.

Permanent tunneled silicone central venous catheters for autologous PBPC harvest in children and young adults

“…Harvest results, efficiency and changes in peripheral blood and serum values after apheresis are comparable or superior to results reported by other groups using different central venous catheters. [5][6][7][8][9] The influence of body size or age on harvest efficiency was neg- Table 5 Side-effects ligible, and the need for additional CVC apheresis placements could be reduced to a minimum. When using tunneled silicone rubber catheters for PBPC harvesting, pitfalls can be prevented by appropriate placement of the catheter tip.…”

“…Madero et al 8 reported on the use of polyurethane CVCs for stem cell apheresis with the Cobe Spectra cell separator in children. Their harvest results were comparable to ours (mean 6.2 × 10 6 CD34 + cells/kg) and they report a mean CD34 harvest efficacy of 42.78%.…”

“…[1][2][3][4] Most problems, such as reduced harvest efficiency and tolerability have been improved by adaptations of the cell separator and by reduction of extracorporal volume. [5][6][7][8] However, the management of safe vascular access, allowing a sustained adequate flow ratio over an extended time frame on repeated occasions, remains a serious practical problem.…”

“…8,10 Children with high risk malignancies primarily receive silicone CVCs at the initiation of chemotherapy, leaving their peripheral veins in good condition. These CVCs are adapted to the patient's size by shortening the distal tip during insertion.…”

Technique for PBSC harvesting in children of weight under 10 kg

“…The use of standard tunnelled double lumen CVC for leukapheresis in children was advocated by several groups. 4,5,[17][18][19] The CVC size should correspond with the patient's weight and, therefore, the CVC flow capacity could create difficulties in maintaining an interface in very small patients. 4 Tunnelled silicon-based catheters tend to collapse, their flow rate is significantly lower, and the ports are side by side which causes recirculation of drawn and returned (processed) blood, decreasing collection efficacy.…”