Apheresis: another indication for radiologically placed central venous catheters

Objective: Apheresis is an important technique, used increasingly for a var iety of conditions. It is sometimes performed via peripheral access because of concern over major complications associated with central venous cathete r (CVC) placement. This study was to determine the safety and success of ra diologic placement of CVCs for apheresis. Methods: Data were collected pros pectively for 278 CVCs placed under real-time sonographic or fluoroscopic g uidance iri the radiology department. Complications were noted in all cases ; the number of passes required for venipuncture and whether this was achie ved with a single wall puncture were noted in 265 cases; duration of cathet erization and reason far removal of the catheter were recorded in all cases . The study group included 83 donors providing peripheral blood stem cells for allogeneic transplant. Results: CVCs were successfully placed in all pa tients, 269 in the internal jugular and 9 in the femoral vein. In 87% of ca ses, only a single pass was required, and in 80% of cases venipuncture was achieved with a single anterior wall puncture. There was inadvertent but cl inically insignificant arterial puncture in 6 cases (2%). In no case did th is prevent CVC placement. Most catheters (211/274, 77%) were removed the sa me day. Only 3 catheters were removed prematurely (1%), 1 because of infect ion and 2 because of clotting. There was 1 case of venous bleeding. Conclus ion: CVCs are safe for apheresis if real-time sonographic guidance is used for the puncture, guide wire and catheter placement are confirmed fluorosco pically, and the duration of catheterization is short.