Two methods for improved venous access in acute leukemia patients.

Arteriovenous fistulae and long-term indwelling right atrial (Hickman) catheters have been used as methods to improve venous access in patients with acute leukemia. The creation of 28 fistulae provided short duration of function (median, 12 days), with eight fistulae functioning less than 24 hours. Complications were negligible, and no increase in the incidence of bacteremia occurred. Fifty-one Hickman catheters have been placed, with a median placement granulocyte count of 335/microliters. The median duration of function has been 91 days or more, with 19 still functioning and 25 other catheters functioning at the time of the patient's death. Complications have been minimal, with substantial postoperative hemorrhage occurring primarily in patients with active disseminated intravascular coagulopathy at the time of catheter placement. Catheter-associated infections were uncommon. The overall incidence of bacteremia was not increased in patients with Hickman catheters, and 28 of the 30 bacteremias that occurred while catheters were in place (three catheter associated) resolved without catheter removal. The Hickman catheter is a safe, reliable device for improvement of venous access in adult patients with acute leukemia.