154 Use of Double Lumen Central Venous Cathethers for Hematopoeitic Stem Cell Pheresis

Track: Poster Abstracts
Wednesday, February 11, 2015, 6:45 PM-7:45 PM
Grand Hall CD (Manchester Grand Hyatt)
Hilary Haines, MD , Pediatrics, Division of Pediatric Hematology/Oncology, University of Alabama Birmingham, Birmingham, AL
Teresa Meadows, CRNP , Children's Hospital of Alabama, Birmingham, AL
Frederick Goldman, MD , Department of Pediatrics, The University of Alabama at Birmingham, Birmingham, AL
Joseph H. Chewning, MD , Pediatric Blood and Marrow Transplantation, University of Alabama at Birmingham, Birmingham, AL
Presentation recording not available for download or distribution as requested by the presenting author.

Background and Methods:  Large bore venous catheters such as Vas-cath or hemodialysis catheters are recommended for stem cell pheresis but rarely placed for routine chemotherapy requiring placement of a second line for pheresis.  Timing pheresis with count recovery and stem cell collection can be logistically challenging.  Due to these challenges and desire to avoid additional line placement and anesthesia, we attempted to use double lumen central venous lines (CVL) for stem cell pheresis in patients who had them at the time of referral.

Results:  Twenty-seven patients underwent stem cell pheresis for autologous stem cell transplant from January 2012 to October 2014 utilizing a Cobe Spectra.  Patient characteristics and results (as means/medians and ranges) are detailed in Table 1. Double lumen CVL was used preferentially for stem cell pheresis if there was one placed at diagnosis for chemotherapy and present at time of referral.  Thirteen patients referred for stem cell pheresis had double lumen CVL (usually 7-9 Fr double lumen Broviacs).  The remaining fourteen patients had either no central line or had implanted ports and therefore had a Vascath placed on the morning of pheresis.  Twelve patients completed pheresis and reached target CD34 collection through double lumen CVL.  One patient was unable to complete pheresis via his CVL and had a successful pheresis the following day after Vascath placement.   Median inlet flow rates were significantly lower in patients undergoing pheresis with a double lumen CVL when compared to patients undergoing pheresis via Vascath and there was a significantly higher rate of pressure error readings in patients with CVLs.  Time from admission to start of pheresis was significantly less in patients who underwent pheresis with a CVL.  There was no significant difference in time on machine, CD34/kg collected, or number of days of pheresis. 

Conclusion:  Hematopoietic stem cell pheresis utilizing double lumen CVL is feasible with the potential benefits of shorter hospitalization and avoidance of second line placement.

 

 

Vascath (15)

CVL (12)

p-value

Diagnosis

      Neuroblastoma/Ganglioneuroblastoma

      CNS tumor

      Retinoblastoma

      Lymphoma

      Ewing's Sarcoma

8

3

1

2

1

7

4

0

1

0

 

Mean # pheresis days

1.2   (1-3)

1.3   (1-2)

0.62

Median Weight (kg)

22    (10-120.9)

15.4    (7.45-45.6)

0.06

Median peripheral blood absolute CD34 count day 1

206   (35.6-766)

354 (12.8-928)

0.5

Median CD34/kg collected  (X 106)

21.5    (6.5-111)

46.7    (13.3-101)

0.06

Median Time from admit to pheresis start (minutes)

333  (190-607)

179  (80-453)

0.0002

Median Total Time on Machine (minutes)

245   (121-851)

281  (180-582)

0.3

Mean Inlet Flow Rate (ml/min)

70.1    (15.9-128.5)

25.5    (9.8-54)

0.002

Mean Inlet Flow Rate/Kg

1.56    (0.7-3.95)

2.22    (1.18-2.06)

0.03

Mean # Pressure/flow error readings

0.6    (0-6)

2.4    (0-5)

0.01

 

Disclosures:
Nothing To Disclose
See more of: Poster Session 1: Autologous Transplants
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