Image-guided central venous catheters for apheresis

Abstract

Summary:Apheresis is an increasingly important procedure in the treatment of a variety of conditions, sometimes performed via peripheral access because of concern over major complications associated with central venous catheter (CVC) placement. This study sought to determine the safety and success for ultrasound and fluoroscopically guided, non-tunneled dual lumen CVCs placed for apheresis. Prospective data collection was made of 200 attempted CVC placements in the radiology department utilizing real time sonographic guidance. The complications relating to placement were noted in all and the number of passes required for venepuncture and whether a single wall puncture was achieved was recorded in 185 cases. Duration of catheterization and reason for line removal were recorded in all. Our study group included 71 donors providing peripheral blood stem cells for allogeneic transplant. CVCs were successfully placed in all patients, 191 lines in the internal jugular and seven in the femoral vein. 86.5% required only a single pass and 80.5% with only anterior wall puncture. Inadvertent but clinically insignificant arterial puncture occurred in six (3%) cases. In no case did this prevent line placement. There were no other procedure-related complications. 173 (87.4%) catheters were removed the same day. No catheters were removed prematurely. There was one case of prolonged venous bleeding. Our study demonstrates the safety of central venous catheters for apheresis provided that duration of catheterization is short and real-time sonographic guidance is used for the puncture, and guide wire and catheter placement are confirmed fluoroscopically.

Use of hand-held ultrasonography to confirm the correct placement of a central venous catheter tip

“…16 nique is that the operator can manipulate the tip of the catheter through to its fi nal position under real-time guidance, and catheter inversion can be almost completely prevented. However, the disadvantages of this method include an additional risk for the patient during transfer, especially when the patient is critically ill, and the signifi cant time and effort necessary for the hospital staff to complete the procedure in the fl uoroscopy suite and to carry out transfers.…”

Ultrasound confirmation of guidewire position may eliminate accidental arterial dilatation during central venous cannulation

“…Not only does it result in a significant reduction in complications as well as greater first-pass success [1,2,4,7], it can also be used to confirm proper guidewire position and post line insertion to screen for complications such as pneumothorax [8]. In an extensive meta-analysis, ultrasound guidance significantly reduced internal jugular and subclavian placement failure (relative risk [RR] 0.32; 95% confidence interval [CI] 0.18-0.55), decreased complications during catheter placement (RR 0.22; 95% CI 0.18-0.55) and lowered the need for multiple catheter placement attempts (RR 0.6; 95% CI 0.45-0.79) when compared with the standard landmark placement technique [1].…”

Image-guided central venous catheter placement for apheresis in allogeneic stem cell donors

“…Mean age was 38 years (range 17-75). The first 71 catheters placed in this patient population were also included in our earlier report [6].…”

“…Central venous access is our technique of choice in all patients undergoing apheresis [6], including allogeneic and autologous hemopoeitic progenitor cell transplantation and therapeutic plasmaspheresis.…”

“…Apart from our own earlier experience [6], there is no literature concerning the use of CVCs to harvest PBSC in donors.…”