Reducing Central Venous Catheter Use in Peripheral Blood Stem Cell Donation: Quality Improvement Report

Abstract

Peripheral blood stem cell (PBSC) collection from donors through apheresis has become the main source of stem cells for hematopoietic stem cell transplantation. This procedure requires a high blood flow venous access. A peripheral venous catheter (PVC), compared to a central venous catheter (CVC), is considered to provide safer venous access. However, initially at our institution, King Abdul-Aziz Medical City - Riyadh, a CVC was frequently used (72%). A quality improvement multidisciplinary team has been formed to conduct a systematic quality performance analysis to evaluate the current process of collecting donor PBSCs with the aim to reduce CVC use to less than the international benchmark (20%). A quality improvement methodology, rapid cycles of plan-do-study-act (PDSA), was used to test a set of initiatives. An Intravenous (IV) team assessed the donor's venous access and inserted an appropriate PVC when feasible. This project ran over 16 months with 42 adult donors undergoing PBSC collection. During the first PDSA cycle, 1 CVC was inserted for every 4 donors. In the second PDSA cycle, 1 CVC was inserted for every 8 apheresis donations. In the third PDSA cycle, no CVC was used for 30 apheresis donations. The targeted stem cell dose was collected successfully in one apheresis session in all donors assigned for PVC access with no complications. A significant reduction of CVC use from 72% to 0% was achieved. This quality improvement project demonstrated that a successful apheresis procedure can be achieved easily and safely in the majority of PBSC donors preventing the potential adverse events associated with CVCs. The interdisciplinary collaboration between the IV team, apheresis and clinical hematology teams was paramount to optimize the safe care of donors.

Peripheral venous catheter collection of immune effector cells and hematopoietic stem cells is feasible and safe in older pediatric patients

“…As in many institutions, the collection of HSCs and IECs at our hospital involves coordination among multiple departments and clinical workflow is important to keep in perspective. Standardization of workflow was beneficial in the current study as has been reported previously in adults 10 . Point‐of‐care ultrasound was successful in identifying an individual inappropriate for PVC collection as has previously been reported for adult patients 10 .…”

“…Standardization of workflow was beneficial in the current study as has been reported previously in adults 10 . Point‐of‐care ultrasound was successful in identifying an individual inappropriate for PVC collection as has previously been reported for adult patients 10 . Further, ultrasound use for insertion of PVC on procedure day was useful for insertion of larger catheter and this technique is well tolerated in children 20 …”

“…10 Point-of-care ultrasound was successful in identifying an individual inappropriate for PVC collection as has previously been reported for adult patients. 10 Further, ultrasound use for insertion of PVC on procedure day was useful for insertion of larger catheter and this technique is well tolerated in children. 20 Limitations of this study include the relatively small sample size and retrospective nature of the study.…”

“…Advances in apheresis technology for the collection of HSCs and IECs have improved significantly over the past 20 years when peripheral blood stem cell collections began to replace bone marrow harvest as a procedure of choice in adults 5–7 . Generally, adult collections have moved away from Central Venous Catheters (CVCs) to routinely utilize Peripheral Venous Catheters (PVCs) to reduce risks of complications to patients 8–10 …”

“…[5][6][7] Generally, adult collections have moved away from Central Venous Catheters (CVCs) to routinely utilize Peripheral Venous Catheters (PVCs) to reduce risks of complications to patients. [8][9][10] Children present unique challenges for apheresis collection-due to smaller patient size, peripheral venous access is more challenging than in larger adult patients. 11,12 For this reason, the use of central venous catheters (CVCs) is standard practice at many pediatric centers to maintain adequate flow rates during apheresis.…”