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Central Venous Catheter Used to Collect Stem Cells for Treatment of Multiple Myeloma
Depending on the specific chemotherapy regimen used, multiple myeloma patients may find that they need an autologous stem cell transplant (stem cells taken from the patient and returned to the same patient.) Arkansas’ treatment is one. Such a regimen combines chemotherapy with autologous stem cell transplantation. To collect stem cells from someone’s bloodstream, a central venous catheter is usually inserted into the jugular vein at the base of the neck. This article describes the details of this procedure from the patient’s point of view.
One might expect that to collect certain blood cells, they would draw blood from one arm through an IV and return it to the other arm through another IV. However, this is usually not the case. This procedure is usually accomplished by inserting a central venous catheter at the base of the neck into the jugular vein. It sounds a lot less reasonable or pleasant, but it turns out to be a relatively simple process.
Central venous catheters have a plastic base (at their center), with several plastic tubes coming out of the top of the base that end with a lumen to which IV lines can easily be attached. From the base of the foot, a large straight plastic tube extends about 6 to 8 inches to a smooth tapered tip. Close inspection shows a hole at the tip and one or two holes around the circumference of the tube. The tip orifice is connected to one or more lumens and the peripheral orifice is connected to one or more other lumens. A typical catheter inserted into the patient’s neck usually has three lumens – two large and one small.
The design of the catheter allows one lumen to be used to draw blood from the vein, leaving the other lumen free to return to the vein and the third to administer medication if needed.
Catheter insertion involves inserting a tapered tube through the skin at the base of the neck and into the jugular vein. The tube then travels down (into) the vein so the tip is positioned in the great vein just above the entrance to the heart. It is admitted by a doctor in an operating suite in a hospital.
A typical procedure proceeds as follows: After arriving in the collection room, the patient lies on a bed and the bed is moved to the operating room where the patient is rolled off the bed and onto the operating table. Then, the nursing staff begins preparing for the procedure. The doctor who is going to insert the catheter will ask the patient questions to make sure that they are both in the right place and that he is doing the right procedure.
The operating suite will typically be equipped with several computer monitors overhead so that the doctor can see when inserting the catheter that he has correctly positioned its business end at the entrance to the heart. The patient will usually be given a nasal cannula with oxygen for breathing and a blood pressure cuff will be attached to his arm to measure his blood pressure during the procedure. The patient will then be covered with sheets – the only exposed area will be the area around the point where the catheter is inserted. When all the preparations are ready, drugs are given to relax (and often sleep) the patient. A local anesthetic is administered to numb the insertion site. A nurse will be assigned to closely monitor the patient while others will assist the doctor. The entire admission process takes only a few minutes.
Before you know it, they’ll ask if you stayed awake during the entire procedure, and if you’d please go back to your bed. Another quick ride down the hallway will return the patient to the stem cell collection room where the newly inserted catheter will be attached to the collection machine and put to use immediately.
A central venous catheter and a PICC line (peripherally inserted central catheter.) There are two major differences between a PICC line. PICC lines are usually attached to the patient’s arm with strong adhesive brackets. Central venous catheters are usually anchored to multiple suture sites. The patient may not know this until the nurse, who wants to remove the catheter, tells her that she must first remove the anchored stitches.
Another difference is that the tubing of a central venous catheter has a larger diameter than a PICC line. This allows more blood to flow easily from the patient to the collection device and back again.
A stem cell collection machine is a device based on a continuous centrifuge. Because stem cells are small and light, when spun in a centrifuge they float to the top where they can be easily separated and collected. The remaining blood is then returned to the patient almost immediately.
A central venous catheter is considered a “temporary” device – it can stay in for a maximum of 5 days. After that, it has to be removed and the stem cell collection has to be stopped. In most cases, sufficient stem cells will be collected within the five days allowed. In some cases, one day of collection is sufficient. Once collection is complete, the central venous catheter can be removed.
The removal procedure only requires removal of the anchoring sutures and withdrawal of the catheter. No need for anesthesia. After the catheter is out, pressure will be applied to the access site for about 10 minutes. Then, the vein and skin should be sealed enough that a bandage can be applied and the patient sent on his way.
While one may be concerned about having a catheter inserted into a jugular vein at the base of the neck, this is a normal procedure that is not painful and should not be feared. Many patients find that they become anxious for no apparent reason. The induction process is quick and a day spent collecting stem cells is usually a long, slow, lazy, relaxing day. Watching TV, reading, sleeping, working on computer, listening to radio, eating and drinking etc. are all allowed. The only restriction is that the patient remains in bed while the tubes are connected from the catheter to the collection machine. Collection usually ends around 3pm at which time the patient is released from the collection machine and bed.
When it comes time to remove the catheter, once again, it sounds worse than it really is. This is a painless procedure that can be performed by a transplant nurse at a cancer clinic.
For those who need to have this catheter inserted and eventually removed, the main recommendation is not to worry about it. The procedures are quick and relatively painless. The initial shot of anesthetic in the neck may feel like a bee sting, but only momentarily until anesthesia wears off. Then, the biggest disadvantage is that the dangling lumens are awkwardly located at the base of the neck. Usually, the catheter is not painful and hardly noticeable. If it is positioned correctly, the only way the patient can see it is by looking in a mirror.
In the bigger picture of things, a central venous catheter is a handy tool to use to perform stem cell collection procedures. Hindsight suggests that it is not worth worrying about or getting excited about. Other aspects of chemotherapy treatment can be worse than the day spent collecting stem cells.
The description given here is typical of this procedure – given from the patient’s perspective. Complications can occur that make the procedure feel very different to other patients. But this description of events is typical for many patients. Hopefully, those who read this article will see that this is a simple, routine process that isn’t worth losing too much sleep over.
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