bloodjourГематология и трансфузиологияRussian journal of hematology and transfusiology0234-57302411-3042ООО Издательский дом «Практика»10.35754/0234-5730-2019-64-4-396-411bloodjour-162Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESОБЕСПЕЧЕНИЕ ЦЕНТРАЛЬНОГО ВЕНОЗНОГО ДОСТУПА ПРИ ТРАНСПЛАНТАЦИИ АЛЛОГЕННЫХ ГЕМОПОЭТИЧЕСКИХ СТВОЛОВЫХ КЛЕТОКPROVISION OF CENTRAL VENOUS ACCESS DURING ALLOGENEIC HAEMATOPOIETIC STEM CELL TRANSPLANTATIONhttps://orcid.org/0000-0001-7048-060XСпиринМ. В.SpirinM. V.

Спирин Михаил Васильевич, врач отделения реанимации и интенсивной терапии

Mikhail V. Spirin, Physician, Resuscitation and Intensive Care Unit

mvspirin@gmail.comhttps://orcid.org/0000-0001-8818-8949ГалстянГ. М.GalstyanG. M.

Галстян Геннадий Мартинович, доктор медицинских наук, заведующий отделением реанимации и интенсивной терапии 

тел.: +7 (495) 612-48-59

Gennady M. Galstyan, Dr. Sci. (Med.), Head of the Resuscitation and Intensive Care Unit

gengalst@gmail.comhttps://orcid.org/0000-0001-9431-8316ДроковМ. Ю.DrokovM. Yu.

Дроков Михаил Юрьевич, кандидат медицинских наук, научный сотрудник отделения интенсивной высокодозной химиотерапии и  трансплантации костного мозга с круглосуточным и дневным стационарами в составе отдела химиотерапии гемобластозов, депрессий кроветворения и  трансплантации костного мозга

Mikhail Yu. Drokov, Cand. Sci. (Med.), Researcher, Department of Intensive High-Dose Chemotherapy and Bone Marrow Transplantation with 24-hour and day in-patient facilities, Department for Chemotherapy of Hematological Malignancies, Hematopoietic Depressions and Bone Marrow Transplantation

mdrokov@gmail.comhttps://orcid.org/0000-0001-6201-6276КузьминаЛ. А.KuzminaL. A.

Кузьмина Лариса Анатольевна, кандидат медицинских наук, заведующая отделением интенсивной высокодозной химиотерапии и трансплантации костного мозга с круглосуточным и дневным стационарами

Larisa A. Kuzmina, Cand. Sci. (Med.), Head of the Department of Intensive High-Dose Chemotherapy and Bone Marrow Transplantation

Kuzmina.L@blood.ruhttps://orcid.org/0000-0001-5973-5763КлясоваГ. А.KlyasovaG. A.

Клясова Галина Александровна, доктор медицинских наук, профессор, заведующая лабораторией клинической бактериологии, микологии и антибиотической терапии

Galina А. Klyasova, Dr. Sci. (Med.), Prof., Head of the Laboratory of Clinical Bacteriology, Mycology and Antibiotic Therapy

Klyasova.g@blood.ruhttps://orcid.org/0000-0001-6177-3566ПаровичниковаЕ. Н.ParovichnikovaE. N.

Паровичникова Елена Николаевна, доктор медицинских наук, руководитель отдела химиотерапии гемобластозов, депрессий кроветворения и трансплантации костного мозга

Elena N. Parovichnikova, Dr. Sci. (Med.), Head of the Department of Chemotherapy of Hematological malignancies and Hematopoietic Depressions and Bone Marrow Transplantation

parovichnikova@gmail.comhttps://orcid.org/0000-0001-8188-5557СавченкоВ. Г.SavchenkoV. G.

Савченко Валерий Григорьевич, доктор медицинских наук, академик РАН, профессор, генеральный директор ФГБУ «Национальный медицинский исследовательский центр гематологии» Министерства здравоохранения

Valery G. Savchenko, Dr. Sci. (Med.), RAS Academician, Prof., Head

director@blood.ruФГБУ «Национальный медицинский исследовательский центр гематологии» Министерства здравоохранения Российской ФедерацииРоссияNational Research Center for HematologyRussian Federation201911122019644396–411Copyright © Спирин М.В., Галстян Г.М., Дроков М.Ю., Кузьмина Л.А., Клясова Г.А., Паровичникова Е.Н., Савченко В.Г., 20192019Спирин М.В., Галстян Г.М., Дроков М.Ю., Кузьмина Л.А., Клясова Г.А., Паровичникова Е.Н., Савченко В.Г.Spirin M.V., Galstyan G.M., Drokov M.Y., Kuzmina L.A., Klyasova G.A., Parovichnikova E.N., Savchenko V.G.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.htjournal.ru/jour/article/view/162Введение

Введение. Проведение трансплантации аллогенных гемопоэтических стволовых клеток (алло-ТГСК) невозможно без центрального венозного катетера (ЦВК).

Цель — определить тактику обеспечения венозного доступа при проведении алло-ТГСК.

Материалы и методы

Материалы и методы. В проспективное нерандомизированное одноцентровое исследование включены 146 больных (70 мужчин и 76 женщин, медиана возраста 37 лет), которым выполнена первая алло-ТГСК. Перед кондиционированием устанавливали один из видов ЦВК: силиконовые двухпросветные туннелируемые катетеры Хикмана или Леонарда (Bard Access System) или полиуретановые нетуннелируемые ЦВК (Certofix Duo или катетеры с антибактериальным покрытием Certofix “Protect” Duo, В. Вraun). Регистрировали ранние осложнения, механические осложнения, катетер-ассоциированные тромбозы (КАТ), катетер-ассоциированную инфекцию (КАИК), туннельную инфекцию и инфекцию выходного отверстия.

Результаты

Результаты. Всего установили 320 ЦВК (146 перед алло-ТГСК и 174 — в посттрансплантационном периоде), из них 259 нетуннелируемых и 61 туннелируемый ЦВК. Нетуннелируемые ЦВК эксплуатировали от 1 до 123 дней (медиана 22 дня), туннелируемые ЦВК — 9–621 день (медиана 146 дней). При использовании нетуннелируемых ЦВК выявлено 2,7 % (1,0/1000 катетеро-дней) механических осложнений и 9 % КАТ (1,4/1000 катетеро-дней). При использовании туннелируемых ЦВК были следующие осложнения: случайное удаление — 1 (1,6 %), разрыв катетера — 4 (6,5 %), КАТ вывили у 5 (8,2 %) больных (0,3/1000 катетеро-дней); обструкция катетера — у 18 (29,5 %) больных, из них у 14 (77,7 %) функция ЦВК восстановлена, у 4 (22,3 %) — катетер удален. Инцидентность КАИК нетуннелируемых ЦВК — 4,4/1000 катетеро-дней, туннелируемых ЦВК — 1,5/1000 катетеро-дней. Не выявлено значимых различий вероятности развития КАИК между нетуннелируемыми ЦВК с антибактериальным покрытием и без покрытия (р = 0,298), а также между нетуннелируемыми и туннелируемыми ЦВК в первые 28 дней от момента установки (р = 0,424). Риск развития КАИК при использовании туннелируемых ЦВК увеличивался после 150-го дня эксплуатации.

Заключение

Заключение. Проведение алло-ТГСК возможно с использованием любого типа ЦВК. Не выявлено преимуществ использования нетуннелируемых ЦВК с антибактериальным покрытием по сравнению с нетуннелируемыми ЦВК без антибактериального покрытия. Применение туннелируемых ЦВК позволяет, в отличие от нетуннелируемых ЦВК, использовать один катетер на протяжении всего трансплантационного и посттрансплантационного периодов, при этом длительность использования туннелируемого ЦВК не должна превышать 150 дней, потому что при более длительном использовании резко увеличивается риск его инфицирования.

Финансирование

Финансирование: исследование не имело спонсорской поддержки.

Introduction

Introduction. The transplantation of allogeneic haematopoietic stem cells (allo-HSCT) is impossible without a central venous catheter (CVC).

Aim

Aim. To determine an optimal approach to providing venous access during allo-HSCT.

Materials and methods

Materials and methods. This prospective, non-randomised, single-centre study included 146 patients (70 men and 76 women, median age 37 years) who underwent the first allo-HSCT. Prior to conditioning, one of the following CVCs was placed: Hickman or Leonard tunnelled double-lumen silicone catheters (BardAccessSystem); polyurethane non-tunnelled CVCs without (Certofix Duo, B. Braun) or with an antibacterial coating (Certofix Protect Duo, B. Braun). The following complications were recorded: early complications, mechanical complications, catheter-associated thrombosis (CAT), catheterrelated bloodstream infections (CRBSI), as well as catheter exit-site and tunnel infections.

Results

Results. A total of 320 CVCs were placed (146 prior to allo-HSCT and 174 in the post-transplant period); 259 of the CVCs were non-tunnelled and 61 were tunnelled. Non-tunnelled CVCs were used for 1–123 days (median 22 days), whereas tunnelled CVCs were implanted for 9–621 days (median 146 days). The use of non-tunnelled CVCs was associated with 2.7 % (1.0/1000 catheter days) of mechanical complications and 9 % of CAT (1.4 / 1000 catheter days). The use of tunnelled CVCs was associated with the following complications: accidental removal — 1 (1.6 %), catheter rupture — 4 (6.5 %), CAT — 5 (8.2 %) patients (0.3 / 1000 catheter days); 18 (29.5 %) patients exhibited catheter obstruction, with CVC function being restored in 14 (77.7 %) patients, whereas in 4 (22.3 %) patients the CVC was removed. The incidence of CRBSI associated with non-tunnelled and tunnelled CVCs was 4.4 and 1.5 per 1000 catheter days, respectively. The study revealed no significant differences in the probability of developing CRBSI between non-tunnelled CVCs with and without antibacterial coating (p = 0.298), as well as between non-tunnelled and tunnelled CVCs in the first 28 days after the catheter placement (p = 0.424). The risk of developing CRBSI when using tunnelled CVCs increased after 150 days of use.

Conclusion

Conclusion. Allo-HSCT can be performed using any CVC type. Our study revealed no advantages in employing nontunnelled CVCs with an antibacterial coating compared to those having no coating. Tunnelled CVCs (as opposed to nontunnelled ones) provide the opportunity to employ a single catheter throughout the entire transplantation and post-transplant period. It should be noted that tunnelled CVCs should not be used for more than 150 days, since prolonged use of such CVCs significantly increases the risk of infection.

Conflict of interest

Conflict of interest: the authors declare no conflict of interest.

Financial disclosure

Financial disclosure: the study had no sponsorship.

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The authors declare that there are no conflicts of interest present.