Related Experiment Videos
Translumbar inferior vena cava catheters: experience with 58 catheters in peripheral stem cell collection and
W D Haire1, R P Lieberman, G B Lund
1Departments of Internal Medicine, University of Nebraska Medical Center, Omaha 68105.
Insights
Translumbar apheresis catheters provide an effective solution for stem cell collection when peripheral venous access is insufficient. This technique minimizes complications, ensuring successful stem cell transplantation.
Area of Science:
- Vascular Surgery
- Hematology
- Medical Devices
Background:
- Peripheral venous access is often inadequate for stem cell collection via apheresis.
- Subclavian apheresis catheters have a high rate of thrombosis-related failure.
Purpose of the Study:
- To evaluate the efficacy and safety of translumbar inferior vena cava apheresis catheters for stem cell collection.
- To assess the utility of these catheters for venous access during transplantation.
Main Methods:
- Percutaneous translumbar insertion of permanent, subcutaneously tunnelled silicone rubber apheresis catheters into the inferior vena cava.
- Placement of 58 catheters in 54 patients for stem cell collection and subsequent use as venous access devices.
Main Results:
- A low rate of apheresis-related complications (3.6%).
- Access failure occurred in 24% due to thrombosis and 14% due to mechanical issues, with most responding to therapy.
- Catheters functioned well for venous access during transplantation with rare complications.
- No clinical or CT evidence of bleeding post-placement or removal.
Conclusions:
- Percutaneously placed translumbar inferior vena cava apheresis catheters are an effective and safe route for peripheral stem cell collection.
- These catheters can be reliably used for venous access throughout transplantation procedures.
Abstract:
Most patients who need peripheral stem cell transplantation do not have peripheral venous access to allow apheresis for stem cell collection. Subclavian apheresis catheters have an unacceptably high incidence of thrombosis-related access failure. We have used a technique for translumbar insertion of permanent, subcutaneously tunnelled silicone rubber apheresis catheters into the inferior vena to place 58 catheters in 54 patients for stem cell collection. 37 catheters have been left in place for venous access during the transplantation procedures. These catheters had a very low rate of apheresis-related complications (3.6%). Access failure occurred due to thrombosis in 14 catheters (24%) and mechanical complications in 8 (14%) but these responded to standard therapy in all except 3 cases. Catheters functioned well as venous access devices during transplantation with only rare complications during this time. Withdrawal venograms at time of removal of 20 catheters showed a fibrin sheath in 17 cases but caval occlusion in none. There was no clinical or CT scan evidence of bleeding after placement or removal of the catheters. Percutaneously placed translumbar inferior vena cava apheresis catheters are an effective route for peripheral stem cell collection and can be left in place for venous access during transplantation.