Extracorporeal photopheresis with permanent subcutaneous right atrial catheters.
BACKGROUND
Adequate peripheral venous access is crucial for successful extracorporeal photopheresis (ECP). As this approach is not always feasible in older patients and patients with graft-versus-host disease, central venous catheters play an increasing role in providing long-term vascular access for ECP.However, not all catheters are able to deliver the minimum flow rate of 7 ml/min for ECP.


METHODS
Eight different permanent subcutaneous right atrial catheters were connected in vitro to the UVAR-XTS photopheresis system and median flow rates were determined. In addition, in vivo flow rates of patients who received ECP, using either peripheral or central venous access, were determined.


RESULTS
Hemodialysis catheters with an internal diameter of 2.0 or 1.5 x 3.5 mm and a length up to 48 cm provided in vitro flow rates of 27-28 ml/min, almost identical to a peripheral access needle. Central venous catheters with a length of over 90 cm reached flow rates below 7 ml/min and are impractical for ECP. The analysis of 308 ECP collection cycles with peripheral vascular access revealed an average flow rate of 31.5 +/- 6.4 ml/min. Only permanent subcutaneous right atrial catheters made for hemodialysis provided similar flow rates (Quinton PermCath Dual Lumen) (33.7 +/- 4.7 ml/min, n = 198).


CONCLUSIONS
Permanent subcutaneous hemodialysis catheters with a length of maximally 48 cm achieve optimal flow rates for ECP. They represent therefore the central venous access of choice in patients with inadequate peripheral vascular access.
Ständer
Hartmut
H
Department of Dermatology, University Clinic of Münster (UKM), Germany.
Neugebauer
Frank
F
Schneider
Stefan W
SW
Luger
Thomas A
TA
Schiller
Meinhard
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001783:Blood Flow Velocity; D002408:Catheters, Indwelling; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005260:Female; D006086:Graft vs Host Disease / Q000188:drug therapy; D006801:Humans; D006874:Hydrostatic Pressure; D066298:In Vitro Techniques; D016410:Lymphoma, T-Cell, Cutaneous / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy; D017893:Photopheresis / Q000295:instrumentation*; D012189:Retrospective Studies