Obstructed central venous catheters. Restoring function with a 12-hour infusion of low-dose urokinase.

Thrombotic obstruction frequently prohibits infusion through or withdrawal of blood from central venous catheters and can occur in conjunction with symptomatic thrombosis of the subclavian vein. Thirty catheters were radiographically proved to be obstructed by thrombus and had not responded to at least one instillation of 5000 units of urokinase. All catheters were treated with a 12-hour infusion of urokinase at the rate of 40,000 units/hour. The obstructing thrombus was either eliminated or reduced in size in all instances and full function was restored in all but one catheter. No bleeding complications were seen. Six patients with obstructed catheters also had symptoms of subclavian vein thrombosis. All patients with symptoms of subclavian vein obstruction became asymptomatic on anticoagulant therapy even though no attempt at dissolving the thrombus obstructing the subclavian vein was made. A 12-hour infusion of low doses of urokinase can safely salvage function of obstructed catheters that otherwise may require replacement. Patients with concomitant subclavian vein thrombosis become asymptomatic on anticoagulant therapy without need to dissolve the obstructing thrombus.

Translumbar inferior vena cava catheters: safety and efficacy in peripheral blood stem cell transplantation.

Most patients who need peripheral blood stem cell transplantation do not have peripheral venous access that would allow apheresis for stem cell collection. Subclavian apheresis catheters have an unacceptably high incidence of thrombosis-related access failure. A technique has been developed for translumbar placement of permanent, subcutaneously tunneled, silicone rubber apheresis catheters into the inferior vena cava, and 40 of these catheters have been placed in 36 patients for stem cell collection. Twenty-six catheters have been left in place for venous access during the transplantation procedure. These catheters had a very low rate (2.3%) of apheresis-related related complications. Access failure was attributed to thrombosis in 10 catheters (25%) and to mechanical complications in another 9 (22%), but access was regained in all but 4 of these cases. The catheters functioned well as venous access devices during transplantation, only rarely developing complications during that time. Venograms performed at the time of removal of 16 catheters showed no case of caval occlusion. A residual fibrin sheath was found around 14 catheters. There was no clinical or computed tomographic scan evidence of bleeding after placement or removal of the catheters. Percutaneously placed, translumbar inferior vena cava apheresis catheters provide a safe and effective route for the collection of peripheral blood stem cells for transplantation, and they can be left in place for venous access during transplantation.

Translumbar inferior vena cava catheters: experience with 58 catheters in peripheral stem cell collection and transplantation.

Most patients who need peripheral stem cell transplantation do not have peripheral venous access to allow apheresis for stem cell collection. Subclavian apheresis catheters have an unacceptably high incidence of thrombosis-related access failure. We have used a technique for translumbar insertion of permanent, subcutaneously tunnelled silicone rubber apheresis catheters into the inferior vena to place 58 catheters in 54 patients for stem cell collection. 37 catheters have been left in place for venous access during the transplantation procedures. These catheters had a very low rate of apheresis-related complications (3.6%). Access failure occurred due to thrombosis in 14 catheters (24%) and mechanical complications in 8 (14%) but these responded to standard therapy in all except 3 cases. Catheters functioned well as venous access devices during transplantation with only rare complications during this time. Withdrawal venograms at time of removal of 20 catheters showed a fibrin sheath in 17 cases but caval occlusion in none. There was no clinical or CT scan evidence of bleeding after placement or removal of the catheters. Percutaneously placed translumbar inferior vena cava apheresis catheters are an effective route for peripheral stem cell collection and can be left in place for venous access during transplantation.