Hahn U, Goldschmidt H, Salwender H, Haas R, Hunstein W
Department of Internal Medicine V, University of Heidelberg, Germany.
J Clin Apher. 1995;10(1):12-6. doi: 10.1002/jca.2920100104.
In order to establish a peripheral blood stem cell graft, repeated apheresis are necessary in the majority of patients. Each apheresis requires withdrawal and reinfusion of blood with high flow rates. To guarantee these flow rates, large-bore catheters are needed for central venous access. Subcutaneously tunneled silicone catheters (Hickman) caused venous thrombosis in 10-40% of the patients. We therefore used polyurethane large-bore catheters only for the time of peripheral blood stem cells (PBSC) collection. Via a Seldinger guidewire following delineation of the right (160 patients) or left (23 patients) internal jugular vein by ultrasound, 183 apheresis catheters have been inserted when the white blood cell count was > 1.0 x 10(9)/L and a measurable population of CD34+ cells was detected by fluorescence-activated cell sorter analysis. The median flow rate was 70 ml/min (range 50-80 ml/min). We observed the following complications: puncture of the carotid artery in 2%, pneumothorax in 0.5%, local infection in 3%, and catheter-related septicemia in only 2% of the patients. At the time of the removal of the catheters, we detected thrombosis of the internal jugular vein in 5% of the patients by ultrasound. The collection of PBSC with short-term, large-bore catheters is effective and is associated with a low incidence of infection and thrombosis.
为了建立外周血干细胞移植，大多数患者需要反复进行单采术。每次单采术都需要以高流速抽取和回输血液。为确保这些流速，需要使用大口径导管进行中心静脉置管。皮下隧道式硅胶导管（Hickman导管）在10%至40%的患者中会导致静脉血栓形成。因此，我们仅在采集外周血干细胞（PBSC）时使用聚氨酯大口径导管。在通过超声确定右侧（160例患者）或左侧（23例患者）颈内静脉后，经Seldinger导丝，当白细胞计数>1.0×10⁹/L且通过荧光激活细胞分选分析检测到可测量的CD34⁺细胞群时，插入了183根单采导管。中位流速为70毫升/分钟（范围为50 - 80毫升/分钟）。我们观察到以下并发症：2%的患者出现颈动脉穿刺，0.5%的患者出现气胸，3%的患者出现局部感染，仅2%的患者出现导管相关败血症。在拔除导管时，通过超声我们检测到5%的患者出现颈内静脉血栓形成。使用短期大口径导管采集PBSC是有效的，且感染和血栓形成的发生率较低。
