Permanent tunneled silicone central venous catheters for autologous PBPC harvest in children and young adults.
Children with high risk malignancies are usually given permanent (Hickman-type) tunneled silicone rubber central venous catheters (silicone CVCs) for the administration of chemotherapy. In the past, these children received an additional short-term polyurethane dialysis CVC for stem cell apheresis. To avoid placement of an additional short-term CVC, we started in 1995 to use pre-existing silicone CVCs for PBPC harvests. From May 1996 to February 1999 we evaluated 165 harvests in 37 children and 14 young adults (16-28 years) treated with high-dose chemotherapy and stem cell support, comparing CD34+ cell harvest efficiency, catheter tolerability, and complications in three different approaches to vascular access. Pre-existing silicone CVCs (64%) or peripheral venous cannulae (15%) were the first choice for venous access. Only when these failed were polyurethane CVCs (21%) used. No significant difference was seen between these three groups, even after dividing the silicone CVC group (105 harvests in 32 patients) into three subgroups according to weight and age. The most frequent problems were citrate toxicity (n = 33), mechanical obstruction inside (n = 9) and outside the cell separator (n = 2), decreased draw line flow in silicone CVCs (n = 7), decreased draw line flow in peripheral venous cannulae (n = 6), and one occlusion in a polyurethane CVC. Pre-existing CVCs and peripheral venous cannulae functioned efficiently when used as a draw line in 79% of the apheresis procedures without significantly reducing single harvest efficiency or catheter tolerability. Consequently, the risks and costs associated with the placement of a dialysis CVC could be avoided in the majority of cases. Bone Marrow Transplantation (2000) 26, 781-786.
Fischmeister
G
G
St Anna Children's Hospital and Children's Cancer Research Institute, Vienna, Austria.
Witt
V
V
Zaunschirm
H A
HA
Fritsch
G
G
Höcker
P
P
Pötschger
U
U
Zoubek
A
A
Gadner
H
H
D000293:Adolescent; D000328:Adult; D018952:Antigens, CD34; D001672:Biocompatible Materials; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000379:methods*; D002408:Catheters, Indwelling / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D016238:Cytapheresis / Q000379:methods*; D005260:Female; D006801:Humans; D006996:Hypocalcemia / Q000209:etiology; D007223:Infant; D008297:Male; D009369:Neoplasms / Q000628:therapy; D012828:Silicones; D013234:Stem Cells / Q000276:immunology
D018952:Antigens, CD34; D001672:Biocompatible Materials; D012828:Silicones