PROVISION OF CENTRAL VENOUS ACCESS DURING ALLOGENEIC HAEMATOPOIETIC STEM CELL TRANSPLANTATION

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

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

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. 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. 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: the authors declare no conflict of interest.

Financial disclosure: the study had no sponsorship.

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