Lead in synthetic and municipal drinking water varies by field versus laboratory analysis.

Water lead measurements by two field analyzers, relying on anodic stripping voltammetry (ASV) and fluorescence spectroscopy, were compared to reference laboratory measurements by inductively coupled plasma mass spectrometry (ICP-MS) in progressively complex datasets (phases A, B, C), to assess field analyzer performance. Under controlled laboratory quantitative tests of dissolved lead within the field analysis range and optimal temperature range, lead recoveries by ASV ranged within 85-106 % of reference laboratory values (corresponding linear model: y = 0.96x, r2 = 0.99), compared to lower lead recoveries of 60-80 % by fluorescence (y = 0.69x, r2 = 0.99) in phase A. Field analyzer performance deteriorated in three opportunistic laboratory datasets compiled for phase B that contained dissolved lead (ASV: y = 0.80x, r2 = 0.98; no fluorescence data). Further lead underestimations were observed in five field datasets compiled for phase C, some of which contained known particulate lead (ASV: y = 0.54x, r2 = 0.76; fluorescence: y = 0.06x, r2 = 0.38). Deteriorating performance between phases was presumably due to the increasingly complex water matrices and lead particulates present in some phase C subsets (phase A < phase B < phase C). Phase C field samples had lead concentrations that were out-of-range, including a 5 % and 31 % false negative rate by ASV and by fluorescence, respectively. The range of results relevant to the diverse nature of compiled datasets, suggests that unless ideal conditions are known to be present (i.e., the lead content of water is dissolved within the field analysis range and optimal water temperature range), these field lead analyses might only be used as a water screening tool. Given the unknown conditions in many field settings, combined with the lead concentration underestimations including the false negative rates reported herein for field datasets, caution is encouraged when employing ASV and particularly fluorescence field analysis.

Performance and safety of femoral central venous catheters in pediatric autologous peripheral blood stem cell collection.

INTRODUCTION: Autologous peripheral blood hematopoietic progenitor cell collection (A-HPCC) in children typically requires placement of a central venous catheter (CVC) for venous access. There is scant published data regarding the performance and safety of femoral CVCs in pediatric A-HPCC. METHODS: Seven-year, retrospective study of A-HPCC in pediatric patients collected between 2009 and January 2017. Inclusion criteria were an age ≤ 21 years and A-HPCC using a femoral CVC for venous access. Femoral CVC performance was examined by CD34 collection rate, inlet rate, collection efficiency (MNC-FE, CD34-FE), bleeding, flow-related adverse events (AE), CVC removal, and product sterility testing. Statistical analysis and graphing were performed with commercial software. RESULTS: A total of 75/119 (63%) pediatric patients (median age 3 years) met study criteria. Only 16% of children required a CVC for ≥ 3 days. The CD34 collect rate and CD34-FE was stable over time whereas MNC-FE decreased after day 4 in 80% of patients. CD34-FE and MNC-FE showed inter- and intra-patient variability over time and appeared sensitive to plerixafor administration. Femoral CVC showed fewer flow-related AE compared to thoracic CVC, especially in pediatric patients (6.7% vs. 37%, P = 0.0005; OR = 0.12 (95%CI: 0.03-0.45). CVC removal was uneventful in 73/75 (97%) patients with hemostasis achieved after 20-30 min of pressure. In a 10-year period, there were no instances of product contamination associated with femoral CVC colonization. CONCLUSION: Femoral CVC are safe and effective for A-HPCC in young pediatric patients. Femoral CVC performance was maintained over several days with few flow-related alarms when compared to thoracic CVCs.

Procedure-related complications and adverse events associated with pediatric autologous peripheral blood stem cell collection.

INTRODUCTION: Autologous peripheral blood hematopoietic progenitor cell collection (A-HPCC) in pediatric patients is considered relatively safe although technically challenging. Very little is known regarding the incidence, risk factors and impact of procedure-related adverse events (AE) on pediatric A-HPCC outcomes. METHODS: Prospective 4.5-year review of AE associated with pediatric A-HPCC. AE were graded by severity and type. Potential demographic and procedural risk factors, and the impact on product quality, were compared by t-test, chi-square, and linear regression. RESULTS: Sixty-two children underwent 110 A-HPCC, including 36 (58%) under 20 kg. Fifty-five AE were documented in 25.4% A-HPCCs and 39% of children (citrate 25%, access 19%, technical 11%, cardiovascular 0%, allergic 1.8%). No AE were noted in children < 10 kg anticoagulated with heparin. Access and technical AE accounted for 73% of severe AE, with line-related problems underlying most technical AE (87.5%, P = 0.006). AE were more likely in older (P = 0.012), heavier patients (P = 0.02), who frequently required more than one A-HPCC (P = 0.012). In contrast, young children were more likely to experience citrate AE with gastrointestinal symptoms (median age, 6 years; P = 0.076). AE had no impact on CD34 collection rates; however, mean CD34 yields (4.2 vs. 20.4 million/kg; P = 0.0035) were decreased in patients with technical AE due to lower peripheral CD34 counts and a high number of aborted procedures (37%). CONCLUSION: Venous access and flow-related issues are a major factor associated with moderate and severe AE, effecting ∼10% of patients. AE are more frequent with increasing patient age, weight, and number of procedures. J. Clin. Apheresis 32:35-48, 2017. © 2016 Wiley Periodicals, Inc.