High flow PICC for apheresis
Abstract:
Background: Autologous hematopoietic stem cell transplant (HSCT), characterized by high intensity chemotherapy followed by the infusion of HSC previously collected from the peripheral blood, is a procedure used in the treatment of several malignancies. In pediatrics, the apheresis procedure represents a challenge, due to the need for insertion of a rigid central venous catheter (CVC) in small children. The CVC is usually used for stem cell collection and then removed. Later, the patient will need a new device for cell infusion.
Aim: We propose the use of one single catheter for both apheresis and infusion.
Methods: We present five children between 1 and 13 years of age who underwent apheresis using a high flow PICC catheter surgically inserted.
Results: All patients utilized a PICC line double lumen 5Fr (PowerPICC™ 5Fr DL BARD/USA) placed in the brachiocephalic vein tunneled on the chest, inserted under 24 h prior to apheresis to assure the devices were pervious. Three of the patients were diagnosed with solid tumor and one with acute lymphoblastic leukemia (ALL) awaiting Car-T Cell therapy. The four children who underwent autologous HSCT used the same catheter for cell infusion and remained with the catheter following discharge. The child who was submitted for Car-T Cell still awaits infusion and the catheter was removed.
Conclusions: High flow PICC is a viable alternative for apheresis to maintain an adequate flow of 5 ml/s and can be used as a single catheter throughout the HSCT process, reducing the risks from anesthesia and the catheter insertion procedure.
Reference:
Kremer V, Rheinheimer A, Rodrigues AL, Taborda A, Coelho R, Zanette A. The Use of a High Flow PICC Catheter for Stem Cell and Lymphocyte Apheresis: The Initial Experience of a Pediatric Oncology Center in Brazil. J Pediatr Surg. 2024 Feb 24:S0022-3468(24)00104-0. doi: 10.1016/j.jpedsurg.2024.02.022. Epub ahead of print. PMID: 38494399.