Apheresis: another indication for radiologically placed central venous catheters.
OBJECTIVE
Apheresis is an important technique, used increasingly for a variety of conditions. It is sometimes performed via peripheral access because of concern over major complications associated with central venous catheter (CVC) placement. This study was to determine the safety and success of radiologic placement of CVCs for apheresis.


METHODS
Data were collected prospectively for 278 CVCs placed under real-time sonographic or fluoroscopic guidance in the radiology department. Complications were noted in all cases; the number of passes required for venipuncture and whether this was achieved with a single wall puncture were noted in 265 cases; duration of catheterization and reason for removal of the catheter were recorded in all cases. The study group included 83 donors providing peripheral blood stem cells for allogeneic transplant.


RESULTS
CVCs were successfully placed in all patients, 269 in the internal jugular and 9 in the femoral vein. In 87% of cases, only a single pass was required, and in 80% of cases venipuncture was achieved with a single anterior wall puncture. There was inadvertent but clinically insignificant arterial puncture in 6 cases (2%). In no case did this prevent CVC placement. Most catheters (211/274, 77%) were removed the same day. Only 3 catheters were removed prematurely (1%), 1 because of infection and 2 because of clotting. There was 1 case of venous bleeding.


CONCLUSIONS
CVCs are safe for apheresis if real-time sonographic guidance is used for the puncture, guide wire and catheter placement are confirmed fluoroscopically, and the duration of catheterization is short.
Department of Diagnostic Imaging, Foothills Hospital, University of Calgary, Alta.
D J
DJ
Sadler
J C
JC
Saliken
C B
CB
So
R R
RR
Gray
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001781:Blood Component Removal / Q000295:instrumentation*; D002405:Catheterization, Central Venous / Q000295:instrumentation*; D002408:Catheters, Indwelling; D003199:Computer Systems; D005260:Female; D005471:Fluoroscopy / Q000295:instrumentation*; D018380:Hematopoietic Stem Cell Transplantation / Q000295:instrumentation; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000295:instrumentation; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015203:Reproducibility of Results; D014019:Tissue Donors; D014184:Transplantation, Homologous; D014463:Ultrasonography / Q000295:instrumentation*