Vascular access in therapeutic apheresis: One size does not fit all

Abstract

Background Therapeutic apheresis has been used in treating hematological and non‐hematological diseases. For a successful procedure, efficient vascular access is required. Presently, peripheral venous access (PVA), central venous catheterization (CVC), implantable ports, and arteriovenous fistulas (AVFs) are used. This review aims to evaluate different type of access and their pros and cons to help physicians determine the best venous access. Methods The electronic search included PubMed and Google Scholar up to November 2020. The Mesh terms were apheresis, peripheral catheterization, central catheterization, and arteriovenous fistula. Results A total of 228 studies were found through database searching. Two independent authors reviewed the articles using their titles and abstracts; 88 articles were selected and the full text was reviewed. Finally, 26 were included. The inclusion criteria were studies incorporating patients with any indication for apheresis. Conclusion PVA has been promoted in recent years in many centers across the United States to lower the rate of complications associated with vascular access and to make this procedure more accessible. Several factors are involved in selecting appropriate venous access, such as the procedure's duration and frequency, patient's vascular anatomy, and staff's experience. In short‐term procedures, temporary vascular access like PVA or CVC is preferred. Permanent vascular access such as AVF, tunneled cuffed central lines, and implantable ports are more beneficial in prolonged treatment period but each patient has to be evaluated individually by apheresis team for the most appropriate method.

Vascular access for autologous peripheral blood stem cells collection by large volume leukapheresis: Single center experience

“…9,19 For adults, 17 gauge needles are recommended because they can provide blood flow rate up to 80 mL/min, which was confirmed in our study. 9,20 Still, we preferred intravenous cannulas because their placement causes fewer clinical complications related to mechanical trauma such as blood extravasation or infiltration. 21 In contrast to healthy donors, difficulties establishing PVA in patients are not infrequent.…”

“…Peripheral veins can be considered a proper choice for leukapheresis because they can provide the blood flow rate between 50 and 80 mL/min required for centrifugation-based apheresis systems, and their use has lower complication rate and cost. 4,9,10,18 Devices of choice for PVA are dialysis-type steel needles which are usually used for inlet access, and plastic intravenous cannulas which can be used for both inlet and return access, depending on the veins' characteristics. 9,19 For adults, 17 gauge needles are recommended because they can provide blood flow rate up to 80 mL/min, which was confirmed in our study.…”

“…11 Peripherally inserted central catheters, due to their small caliber, are even contraindicated for apheresis, because the high flows and pressures can cause rupture of their walls. 2,9 Device of choice for the leukapheresis is catheter with larger lumen and thicker walls designed for hemodialysis that allows a high flow rate without the collapse of their walls. 7,17 The most common site of catheter placement is the superior vena cava, entered through the subclavian or internal jugular vein because they minimize bacterial contamination and maintain patient mobility.…”

“…3,14 Cannulation through the internal jugular vein is recommended due to higher pneumothorax and hemothorax rates related to subclavian vein anatomical location. 3,9,11 In our center subclavian vein was the most common insertion site, due to preference of the hematologists responsible for CVC placement. Although femoral CVC insertion has a lower complication rate, it is not recommended due to the increased risk of bacterial infection, thrombosis, and reduced mobility, making them very inconvenient for patients.…”

“…Although femoral CVC insertion has a lower complication rate, it is not recommended due to the increased risk of bacterial infection, thrombosis, and reduced mobility, making them very inconvenient for patients. 3,9 In our study, it was used only in 2 patients with contraindications for CVC placement in subclavian or jugular veins.…”