Permanent tunneled silicone central venous catheters for autologous PBPC harvest in children and young adults

Children with high risk malignancies are usually given permanent (Hickman-t ype) tunneled silicone rubber central venous catheters (silicone CVCs) for the administration of chemotherapy, In the past, these children received an additional short-term polyurethane dialysis CVC for stem cell apheresis, T o avoid placement of an additional short-term CVC, we started in 1995 to us e pre-existing silicone CVCs for PBPC harvests. From May 1996 to February 1 999 we evaluated 165 harvests in 37 children and 14 young adults (16-28 yea rs) treated with high-dose chemotherapy and stem cell support, comparing CD 34(+) cell harvest efficiency, catheter tolerability, and complications in three different approaches to vascular access. Pre-existing silicone CVCs ( 64%) or peripheral venous cannulae (15%) were the first choice for venous a ccess. Only when these failed were polyurethane CVCs (21%) used, No signifi cant difference was seen between these three groups, even after dividing th e silicone CVC group (105 harvests in 32 patients) into three subgroups acc ording to weight and age, The most frequent problems were citrate toxicity (n = 33), mechanical obstruction inside (n = 9) and outside the cell separa tor (n = 2), decreased draw line flow in silicone CVCs (n = 7), decreased d raw line flow in peripheral venous cannulae (n = 6), and one occlusion in a polyurethane CVC, Pre-existing CVCs and peripheral venous cannulae functio ned efficiently when used as a draw line in 79% of the apheresis procedures without significantly reducing single harvest efficiency or catheter toler ability. Consequently, the risks and costs associated with the placement of a dialysis CVC could be avoided in the majority of cases.