Will I need a special catheter to harvest stem cells? 

This specific type of catheter. Sometimes depends on the patient themselves. For collection, in some institutions. The folks will come and look at someone's arms and say their veins look like they're sturdy enough or accessible enough where they will not need to have a catheter placed for the collection procedure. But some individuals do have to have a line that's placed in one of the larger veins that goes into the center part of the body for the collection, and that can sometimes be used for the transplant procedure itself. It depends a little bit on the timeline whether someone is going to have the collection done just before they go through with the transplant or whether there's going to be a gap in time. For the transplant procedure, if someone doesn't already have that line in place, then they almost certainly do have to have another central line placed. It's for a few reasons. One is so that the nurses who are helping to take care of a patient during a transplant have enough access where they can put in blood products or other medications, as well as taking blood for the daily and sometimes more than once a day tests that are done. We would like to be able to avoid putting needles into someone's arm multiple times a day because it's pretty uncomfortable. The type of catheter that's chosen is partially dependent, I believe, on hospital practice as well as based on insurance. Some places can get away with using what's called a PICC line, which is a catheter that goes into the arm above the elbow and then feeds up into the center part of the body. Other places use a tunneled line which can go into the chest wall itself and then go directly into the center part of the body.

Is it common to have a catheter with multi-lumens?

I think a lot of that is for the convenience of the nursing staff. If someone ends up being in the hospital for all or for part of their transplant stay. It's nice to be able to have one room and or one access point for getting some medications and then a separate access point because medications aren't always compatible with each other. And we like to be able to not delay any treatments that someone might need.

When are catheters usually removed?

It depends a little bit on the institution itself and how they choose to care for patients during the transplant procedure. Some places keep a patient in the hospital a little longer than other places might, and they might choose to remove the catheter when somebody is going to be leaving the hospital before they go into the outpatient setting. Other institutions will discharge a patient from the hospital a little bit earlier with the plan that they're going to be coming into the outpatient clinic or the infusion center several times a week to have blood drawn and to have labs checked in to get other types of supportive care. If that's the case, then they'll sometimes keep that catheter on perhaps until day 30 or so after the transplant itself.

What should I know about showering?

Well, you can take a shower, but you have to try your hardest to keep the catheter and the dressing associated with it dry.
At our situation, we use mostly PICC lines, so most patients have the catheter in their arm.
There are plastic sleeves that people can use, which are disposable, which will stick to their skin above the dressing itself and hopefully keep things as dry as possible.
Some people MacGyver things using pressing seal from the grocery store to try to create a really nice seal over the line itself.
I've seen that some patients have purchased neoprene sleeves that are kind of made out of wetsuit material that they seem to get off of the Internet somewhere which can also be very effective. They don't want to throw away all the plastic.

What if my catheter dressing gets wet? 

Sometimes the dressing does get wet and it's okay if that happens. You just need to tell somebody about it. At our clinic, the infusion nurses are very accommodating and very understanding, and so patients can call them up and say, "I'm so sorry, my dressing got wet," and they'll get them into the clinic, get that dressing changed, cleaned up, dry it up. And so it's really just very important that we know about it so we can help you take care of the line.

How common is a catheter infection?

Worry about infection and worry about the adhesive lifting off and having dirt or something else. Get close to that site where the line is going into the body.

How are catheters placed?

It depends. So for the PICC lines, those are usually placed by a specialized team of trained nurses or other types of medical professionals who can do the procedure either at the bedside or in a bedside, like setting in a different part of the hospital. And they use a machine similar to an ultrasound, so that they can see where they're going and so that they can feed the line into the right vein in the body. For the tunneled lines, those are generally done in the radiology suite and those are done by radiologists or other staff that work with the radiology physicians. And they're also using X-ray guidance to make sure the line is going in the right place. The PICC lines are usually done without sedation. The lines in the radiology suite, if someone feels very nervous about it, they can sometimes have some medication for anxiety. But generally things are pretty quick. People get some medications so they don't have pain at the site when the skin is being cut.

Why is a catheter necessary during a stem cell harvest?

When you're looking at harvesting your stem cells, we're looking at putting large volumes of your blood through this machine called the leukapheresis machine and trapping your stem cells. And so to do that, you need a very large bore catheter. So it's not too dissimilar from the catheter that is required for dialysis.
And so you can't do it from a regular IV catheter that you put in your arm, for example. So, yes. So you would get a trifusion catheter, again, similar to a dialysis catheter because of the large volumes of blood that are required. And this is to harvest your cells. The transplant itself does not require it, but once we put this catheter in, we tend to keep it throughout your transplant period until we're no longer using it so that we don't tell you do not require a new catheter replacement. If you're somehow dissociating your collection and your harvesting from your transplant, then you would actually then remove the catheter. In doing your transplant, you would have a different catheter.

Do I need a catheter when doing a transplant?

You need a catheter. Because it is high-dose chemotherapy. And I guess it's not necessarily just for that during the transplant and then you got the stem cells infusion. So you want a large catheter to infuse the stem cells. And also you use the catheter to collect the stem cells. So you need the Hickman catheter because the portacath that will not be appropriate for a couple of reasons why, because you are not going to be able to collect the stem cells. They go through the skin, you destroy the stem cells. And also because if you develop an infection, you will need to go through surgery with the Hickman catheter we pull out if you have an infection. So it's easy to manage. And also during the transplant, every day you get blood drawn, you need the infusion antibiotics, a little light. So you need the catheter; it's your best friend. And I always tell the patient we’ll place it for the stem cell collection. And then we pull it, you know, two weeks after when you graft. So it's a very temporary line.

What is a port?

The portacath is a catheter that is inserted by surgery or interventional radiology. So they actually make an incision; it’s under so you don't see anything. And then you have to access the portacath. But we don't use that for transplant for the stem cell collection. We don't. And also because during the transplant that week that the patient developed their myelosuppression, if you have an infection and the portacath gets infected and you don't have blood count, platelets, the surgery will not catch it. So Hickman, the one sticking out and we need the large lumen Hickman, we can pull it at any time. So if you have an infection when you’re in the middle of transplant and we isolate an organism, a bacteria, we can pull that and finish the transplant with a PICC or regular IV.