Two methods for improved venous access in acute leukemia patients

Abstract

Arteriovenous fistulae and long-term indwelling right atrial (Hickman) catheters were 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 8 fistulae functioning less than 24 h. Complications were negligible and no increase in the incidence of bacteremia occurred. Hickman catheters (51) were placed. The median duration of function was 91 days or more, with 9 still functioning and 25 other catheters functioning at the time of the patient''s death. Complications were 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; 28 of the 30 bacteremias that occurred while catheters were in place (3 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.