(P-QU-10) Multiday Use Of Non-Tunneled Central Venous Catheters In Vetted Adult Outpatients Undergoing Apheresis Collections Of Autologous Peripheral Blood Stem Cells
University of New Mexico Department of Pathology Albuquerque, New Mexico, United States
Background/Case Studies: Autologous apheresis peripheral blood stem cell (PBSC) collections are routinely performed to treat a variety of hematologic and oncologic disorders. Vascular access options for these apheresis collections include peripheral veins and central venous catheter (CVC). There is a reluctance to discharge outpatients from the healthcare setting with a non-tunneled CVC due to clinical concerns of bleeding from the catheter site, accidental removal or repositioning, air embolism, line damage, infection, and local tissue injury. We sought to characterize the feasibility and adverse risk rates of multiday non-tunneled CVC use in vetted adult outpatients undergoing autologous apheresis PBSC collections.
Study
Design/Methods: We conducted a retrospective study at our university medical center and comprehensive cancer center of autologous apheresis PBSC collections via a non-tunneled CVC in adult outpatients performed between 2018 and 2023. All patients and caregivers were counseled about the potential risks of having a non-tunneled CVC and were provided education regarding basic care of the CVC in the outpatient setting. All patients had their non-tunneled CVCs successfully placed at least 1 day prior to their apheresis PBSC collections. Data collected included patient demographics, disease indication, number of apheresis procedures, and CVC details including complications such as bleeding from the catheter site, accidental catheter removal or repositioning, air embolism, line damage, infection, and local tissue injury.
Results/Findings: In the 6-year study period, 117 autologous apheresis PBSC collections were performed in 65 adult outpatients via non-tunneled CVCs (see Table 1); all were cannulated in an internal jugular vein. The duration of non-tunneled CVC placement in these outpatients was 3.2 ± 1.2 days. The only observed complication was a minor bleeding event from the catheter site that was successfully controlled with application of manual pressure (1/117, 0.85%). No other reported complications were identified (0/117, 0% for all other risks). The apheresis nursing staff successfully removed CVCs from all patients on the final apheresis PBSC collection day without any complications. Conclusions: Multiday non-tunneled CVC use in vetted adult outpatients undergoing autologous apheresis PBSC collections was feasible and had a good safety profile. This practice allowed apheresis PBSC collections to extend over several days, if necessary, and increased overall PBSC collection yields without the need for a more invasive tunneled CVC to be placed, as well as facilitated easier line removals since non-tunneled CVCs were removed immediately at the bedside after the final apheresis PBSC collections. Prospective monitoring of this strategy will assist in capturing additional low-frequency events.
