Vascular access is of high value to patients undergoing the leukapheresis procedure. With the closed-loop system, two venipuncture sites with strong structural integrity to the veins will cut down on procedure time while simultaneously producing a higher volume and quality of product. Leukapheresis can be administered using peripheral venous access with shortterm cannula insertion or central venous access with catheter implantation depending on venous access and toleration. Thus, finding adequate vascular access with the right insertion tools is an important topic of discussion.
Researchers at the University of Florence Children’s Hospital sought out to find the best solution for adequate vascular access in pediatric patients receiving leukapheresis treatments for the collection of autologous peripheral blood progenitor cells. For these pediatric patients, vascular access differed across the board, allowing for the use of different catheters for venipuncture. According to the study, “the best vascular access is one that provides adequate and consistent flow rates while using the least invasive, most simple, safe, and cost-effective procedure.” With this principle in mind, minimally invasive peripheral radial artery percutaneous catheters (PACs) were used for blood drawals in 85 leukapheresis procedures in 33 patients with either a central (Broviac-type) catheter or peripheral venous access was used for blood returns.
Widely accepted materials used in this study included Vasocan Braunule Leur Lock IV cannulas (20 and 22 gauge) placed peripherally using local anesthetics (i.e. lidocaine) for adequate pain control while general anesthesia was used for central catheter placement. It is important to note that central catheters were placed for those patients undergoing more invasive procedures such as marrow biopsies in addition to the leukapheresis procedure. These indications, in addition to poor venous access, were sufficient reasons to use a central catheter in lieu of peripheral cannulas.
No significant complications were observed in this intensive study, which leads us to the conclusion that either insertion technique for WBC collection and remnant return is safe. A potential complication associated with cannula access is arterial occlusion, though overall cannulation success rates over 97 percent have been reported.
However, catheter placement and use is necessary for those patients who cannot tolerate or will not see a good return on peripheral access. Catheters, for this specific patient population, may be inserted via subclavian, jugular, or femoral depending on the practice and preference of the center. Complications such as pneumothorax and hemothorax as well as thrombocytopenia increase with the use of catheters. Catheters used in a Turkish study of 877 leukapheresis sessions that focused on short-term femoral venous dialysis catheters for venous access were all standard double-parallel-lumen silicone or polyurethane catheter. These catheters, sutured in place with sterile dressings, were removed on the successive day of the final leukapheresis procedure with local pressure applied for decreased risk of hematoma.
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