LARGE-BORE CENTRAL VENOUS CATHETERS FOR THE COLLECTION OF PERIPHERAL-BLOOD STEM-CELLS

In order to establish a peripheral blood stem cell graft, repeated aph ereses are necessary in the majority of patients. Each apheresis requi res withdrawal and reinfusion of blood with high flow rates. To guaran tee these flow rates, large-bore catheters are needed for central veno us access. Subcutaneously tunneled silicone catheters (Hickman) caused venous thrombosis in 10-40% of the patients. We therefore used polyur ethane large-bore catheters only for the time of peripheral blood stem cells (PBSC) collection. Via a Seldinger guidewire following delineat ion of the right (160 patients) or left (23 patients) internal jugular vein by ultrasound, 183 apheresis catheters have been inserted when t he white blood cell count was >1.0 x 10(9)/L and a measurable populati on of CD34(+) cells was detected by fluorescence-activated cell sorter analysis. The median flow rate was 70 ml/min (range 50-80 ml/min). We observed the following complications: puncture of the carotid artery in 2%, pneumothorax in 0.5%, local infection in 3%, and catheter-relat ed septicemia in only 2% of the patients. At the time of the removal o f the catheters, we detected thrombosis of the internal jugular vein i n 5% of the patients by ultrasound. The collection of PBSC with short- term, large-bore catheters is effective and is associated with a low i ncidence of infection and thrombosis. (C) 1995 Wiley-Liss, Inc.