Image-guided central venous catheters for apheresis

Apheresis is an increasingly important procedure in the treatment of a vari ety of conditions, sometimes performed via peripheral access because of con cern over major complications associated with central venous catheter (CVC) placement. This study sought to determine the safety and success for ultra sound and fluoroscopically guided, non-tunneled dual lumen CVCs placed for apheresis, Prospective data collection was made of 200 attempted CVC placem ents 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 ac hieved was recorded in 185 cases. Duration of catheterization and reason fo r line removal were recorded in all, Our study group included 71 donors pro viding peripheral blood stem cells for allogeneic transplant. CVCs were suc cessfully placed in all patients, 191 lines in the internal jugular and sev en in the femoral vein, 86.5% required only a single pass and 80.5% with on ly anterior wall puncture. Inadvertent but clinically insignificant arteria l puncture occurred in six (3%) cases. In no case did this prevent line pla cement. There were no other procedure-related complications. 173 (87.4%) ca theters were removed the same day. No catheters were removed prematurely. T here 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 fluoroscopic ally.