COMPLICATIONS ASSOCIATED WITH CENTRAL VENOUS CATHETERS USED FOR THE COLLECTION OF PERIPHERAL-BLOOD PROGENITOR CELLS TO SUPPORT HIGH-DOSE CHEMOTHERAPY AND AUTOLOGOUS STEM-CELL RESCUE

The purpose of this study was to review the incidence and type of comp lications associated with the insertion and use of central venous cath eters for leukapheresis and high-dose chemotherapy with stem cell resc ue. One hundred sixty-seven central venous catheters placed either at the transplant center or by various community surgeons were studied fo r insertion complications, inability to perform leukapheresis and inci dence of infection. The overall incidence of hemo- or pneumothorax was 3.6%. Inability to pherese occurred in 13% of catheters placed by out side surgeons and 6.5% of catheters inserted at the transplant institu tion. Most often, these were due to malposition of the catheter too hi gh in the superior vena cava or in other veins. Deep venous thrombosis was often related to this malposition and occurred in 4.8% of all pat ients. Pulmonary embolism was not seen in these patients despite the f act the catheters were often left in place during the thrombotic episo de. Early or late-onset infections occurred in 6.5% of patients and we re most often exit site infections. The incidence of complications of pheresis catheters is high but might be reduced by more attention to p roper placement of the catheter closer to the right atrial/superior ve na cava junction, and limiting insertion to a cadre of surgeons famili ar with leukapheresis requirements.