Novel use of a midline catheter for therapeutic and donor apheresis in children and adults

Abstract

Background Apheresis procedures require adequate vascular access to achieve optimal inlet flow rates. While central lines provide such access, their placement and use are associated with risks; some of these risks are minimized if peripheral intravenous access can be established. However, peripheral intravenous access is associated with challenges in the pediatric setting. Research indicates that midline catheters reduce the use of CVADs and their associated risks. The use of midline catheters for apheresis has been reported recently in adults, but no studies have been published on their use in children. Thus, the purpose of this study was to evaluate the use of midline catheters for apheresis in the pediatric setting. Methods A retrospective observational study was conducted to evaluate the safety and efficacy of midline catheters in subjects who underwent apheresis at a pediatric hospital from April 2018 to August 2020. Demographic data, clinical data (diagnosis, procedure, catheter size, body mass), and outcome data (inlet flow rate, total blood volume [TBV] processed, procedure time, and cell counts) were collected. Results Eighteen subjects received a total of 100 midline catheters for 73 apheresis procedures. Inlet flow rates ranged from 45 to 80 mL/min, TBV ranged from 2872 to 20 000 mL, and procedure time ranged from 1.25 to 7 hours. Inlet flow rates met or exceeded the recommended inlet flow rates for apheresis in children and adults (P < .0001). No adverse events occurred. Conclusion Midline catheters provide safe and effective vascular access for apheresis. Future research should include younger patients with lower body mass.

Long peripheral catheters in children: A scoping review

“…One article that met the eligibility criteria was identified post hoc and included in the final review of a total of 21 articles/abstracts. The abstract 19 and publication 20 by Casacchia et al report different outcomes despite a small overlap in population, so both were included.…”

“…The clinical settings varied widely. Most commonly, studies included hospitalized patients (including the neonatal intensive care unit [NICU] 24,25,30,31,35 ), but three studies included outpatients 19,21,34 and one enrolled patient in the emergency department 37 . Specialty populations included neonates, surgical patients, patients with cystic fibrosis, prebone marrow transplant, patients with thalassemia, and patients undergoing apheresis.…”

“…23 One study reported an average blood draw days of 4.2. 33 Two studies looked at the use of LPCs for apheresis and catheters were only kept for the apheresis procedure 19,20 ; one of these studies reported dwell-time of 1.25-7 h. 20 Both apheresis studies reported 100% completion of therapy.…”

“…Two studies compared outcomes between LPCs and central venous catheters. 19,39 Catheter-related complications…”

“…Dwell-time was reported in 17 studies with the overall reported range of dwell-time from 1-48 days. [20][21][22][23][24][25][27][28][29][30][31][32][33][35][36][37][38] The range of average dwell-time was 4.0-11.9 days, and the range of median dwell-time was 4.7-14 days. Fourteen studies reported a percentage of completion of therapy with the initial LPC.…”