When patients and, occasionally, healthy donors have poor arm veins, a St. Paul's central venous catheter must be inserted in order to collect blood stem cells successfully.
The catheter is a hollow, flexible tube made of soft, rubber-like material. It is inserted into one of the large veins in the side of the neck or the groin area. It is usually used to perform cell separation procedures, plasma exchange and blood stem cell collection. It can also be used to perform dialysis or blood specimen collection.
Because the catheter can be left in place in the outpatient setting, it is important that patients and donors are aware of what it is, what possible problems they might have with it, and how to deal with any problems.
To make sure that you know what to expect from the procedure, you will be given a tour of the Cell Separator Unit before the catheter is inserted. The Cell Separator Unit is area where blood stem cells are collected. You will meet with one of the nurses who is a specialist in cell separation procedures and the care of the St. Paul's Catheter for a teaching session.
During this session, you will learn how the catheter is inserted, how to care for it yourself and how to get help if there are any problems. You may bring a friend or family member with you to this session. If you have more questions or concerns, you are encouraged to contact your physician.
On the day of the procedure, you will check in at the Cell Separator Unit on the 6th Floor of the Centennial Pavilion at Vancouver General Hospital. The catheter is inserted in a procedure room at the Radiology Department.
At the Radiology Department, a physician will insert the St. Paul's catheter. Local anaesthetic will be injected into the skin with a very small needle to freeze the area. You will be awake during the procedure. You should not feel much discomfort, but may feel some pressure.
The catheter is inserted through a needle and secured to the skin by two stitches. Then a bandage is applied. The procedure takes about one hour. An x-ray will be taken after the procedure to check the location of the catheter.
Soon after the procedure, you will return to the Cell Separator Unit for assessment and a short recovery period. Some discomfort following insertion is possible. Patients often describe a stiff neck or bruised feeling. This discomfort usually lasts a day or two. Pain medication is available on request or you may receive a prescription for pain medications from the physician ahead of time.
A physician will examine you after the procedure to decide when you are able to go home. You should arrange to have a family member or friend pick you up after the procedure and stay overnight with you. Staff will contact the family member or friend to confirm the time of your discharge. In some cases, the physician will decide to admit the patient to hospital for further monitoring; however, this is unusual.
The evening after line insertion, a nurse will telephone you at home to see how you are doing. You should take your temperature at dinnertime, before eating or drinking anything, and again at bedtime. The nurse will ask you about your temperature, and if there is any pain or bleeding.
Follow these instructions and precautions after the procedure:
Diet: Resume normal diet.
Activity: Rest quietly at home for the rest of the day. Avoid strenuous activity. When the line is in place, do not have a bath or shower. Avoid getting the dressing wet.
Pain: Take pain medication if necessary. Most patients find that plain Tylenol taken a couple of times over the first 24 hours is effective in controlling the minor discomfort that may be experienced. It is not unusual to feel a bit of tenderness, and sometimes some pressure or tightness from the dressing. If you notice any increased pain, you should contact the physician right away.
Bleeding: It is not unusual to see a bit of blood seep through the dressing. If there is bright red blood when the patient returns home, apply pressure directly over the area and contact the physician. Do not remove any part of the dressing.
Infection: Always keep the area around the catheter insertion site clean and dry. Do not shower or bathe while the catheter is in place. Do not remove the dressing or touch the catheter insertion site. You should take your temperature before dinnertime, at bedtime, and when you wake up in the morning. If there is a fever (38°C or higher), chills, a flu-like feeling, lack of energy, or redness, swelling or pus around the catheter insertion site, you should contact the physician immediately.
Line Care: Additional clean gauze may be placed over the dressing if there is a small amount of bleeding. Do not remove any part of the dressing.
The following is a list of possible problems that could occur after the catheter insertion. These problems are serious but rare. However, it is important to know what to do in case they happen.
Puncture of an artery during insertion: The nurse will ensure the line insertion site is not swollen before you leave the hospital. If you see or feel increased swelling and pain at the insertion site, or have shortness of breath, this is anemergency. Apply pressure directly on the insertion site, call 911 and go directly to the nearest Emergency Department.
Puncture of the lung during insertion: The physician will check for this possibility with an x-ray. If you notice shortness of breath or chest pain, be sure to let the nurse or physician know immediately. This is anemergency. If you have shortness of breath or chest pain at home, call 911 and go directly to the nearest Emergency Department.
Air in the catheter (embolism): The nurse will make sure the catheter is flushed properly. Take care not to damage the catheter. If you have shortness of breath, chest pain, dizziness, or confusion, lie down on the left side immediately, close the catheter clamp, and have someone call for help. This is anemergency. Call 911 and go directly to the nearest Emergency Department.
Accidental removal of catheter: The catheter is held in place by a strong suture (stitch). Avoid tugging or pulling on the catheter and make sure it is secured to the skin with tape. If you feel the catheter is partly or completely dislodged, apply pressure directly over the insertion site for 5 minutes or until the bleeding stops and apply waterproof tape. Call the physician immediately.