Multi-purpose silastic dual-lumen central venous catheters for both collection and transplantation of hematopoietic progenitor cells

Autologous peripheral blood progenitor cell (PBPC) transplantation frequent ly requires sequential placement and use of two separate central venous cat heters: (1) a short-term, large-bore, stiff device inserted for leukapheres is, and after removal of that device, (2) a long-term, multi-lumen, flexibl e, Silastic catheter for administration of high-dose chemotherapy, re-infus ion of hematopoietic cells, and intensive supportive care. We reviewed our recent experience with two dual-lumen, large-bore, Silastic multi-purpose ( 'hybrid') catheters, each of which can be used as a single device for both leukapheresis and long-term supportive care throughout the transplant proce ss. Quinton-Raaf PermCath and Bard-Hickman hemodialysis/apheresis dual-lume n catheters were used as the sole venous access device in 112 consecutive p atients who underwent autologous PBPC collection and transplantation. The c atheter exit site was monitored three times a week, and lumen patency was a ssessed using clinical and radiologic techniques. Catheters were removed pr ematurely for persistent thrombus, positive blood cultures despite appropri ate antibiotics, or mechanical dysfunction, There were no intra-operative o r immediate post-operative complications relating to insertion. Thirty-two patients experienced catheter occlusion necessitating urokinase instillatio n. Persistent occlusive problems were noted in 16 patients, and in 10 patie nts the catheter bad to be removed. Two exit site infections and 17 bactere mias occurred. Catheters had to be removed for persistent infection in two subjects and for mechanical problems in five others. Cost analysis comparin g the hybrid catheters alone ys conventional devices revealed a charge of $ 4230 in patients with hybrid catheters vs $7530 in those requiring a tempor ary non-Silastic dialysis catheter in addition to a flexible, long-term Sil astic catheter, Hybrid, Silastic, dual-lumen, large-bore central venous cat heters are safe, cost-effective and convenient multi-purpose venous access devices that may be used in the setting of autologous PBPC collection and t ransplantation. The rate of thrombotic, infectious and mechanical complicat ions appears comparable to other central venous access devices.