Thrombotic complications of subclavian apheresis catheters in cancer patients: prevention with heparin infusion.
Twenty-two silicone rubber apheresis catheters were placed into the subclavian veins of 18 cancer patients to allow serial leukapheresis for collection of circulating hematopoietic stem cells. The tips of the catheters were placed in the innominate vein to avoid reinfusion of citrate into the right atrium and the resulting tendency to cardiac arrhythmias. Sixteen catheters were placed without prophylactic anticoagulation. Anticoagulation was prematurely discontinued in one patient because of the inconvenience of the portable heparin infusion pump. Six of these 17 catheters developed venographically proven thrombotic complications and five others had presumed thrombosis-related access failure or caused symptoms of venous obstruction, but confirmation of the presence of a thrombus with venography was not obtained. Three catheters spontaneously withdrew from the vein, one during urokinase infusion for thrombosis. Only three catheters had uncomplicated apheresis courses. Prophylactic heparin infusions via portable infusion pumps were given after placement of six catheters. As long as the heparin infusions were continued all patients had uncomplicated apheresis courses. One patient's heparin was prematurely discontinued. Within 3 days of its discontinuance, radiographically proven thrombotic catheter occlusion occurred. Patients given heparin were less likely to develop complications (P less than 0.001). No unexpected complications of apheresis were encountered as a result of the use of these catheters. Silicone rubber subclavian catheters can be used for peripheral stem cell collection but have a high frequency of thrombotic complications. Systemic anticoagulation with heparin can minimize the likelihood of these complications.
Haire
W D
WD
Department of Internal Medicine, University of Nebraska Medical Center, Omaha 68105.
Edney
J A
JA
Landmark
J D
JD
Kessinger
A
A
D002405:Catheterization, Central Venous / Q000009:adverse effects*; D006493:Heparin / Q000627:therapeutic use*; D006801:Humans; D007262:Infusions, Intravenous; D007937:Leukapheresis / Q000009:adverse effects*; D009369:Neoplasms / Q000628:therapy*; D013350:Subclavian Vein; D013927:Thrombosis / Q000209:etiology* / Q000517:prevention & control
D006493:Heparin