Accurate tacrolimus monitoring by dual peripherally inserted central catheters in allogeneic HSCT.

Abstract

Introduction: Allogeneic hematopoietic stem-cell transplantation (allo-HSCT) requires reliable vascular access for medication, transfusion, and blood sampling, which often involves painful venipuncture. This prospective study evaluated a novel dual peripherally inserted central venous catheter (PICC) technique to reduce venipuncture frequency in allo-HSCT recipients.

Methods: The study enrolled 29 allo-HSCT recipients. Each patient received two single-lumen PICCs: Catheter A for tacrolimus infusion and Catheter B, positioned distally, for blood sampling. Tacrolimus concentrations from Catheter B and venipuncture were compared using Bland-Altman analysis. Catheter-related adverse events were also evaluated to assess safety.

Results: PICC placement was successful in all patients. During 1378 catheter-days, one catheter-related bloodstream infection and one catheter occlusion occurred. Tacrolimus concentrations from PICC samples were strongly correlated with those of venipuncture samples (r = 0.93). Bland-Altman analysis showed good agreement, with a mean difference of 0.064 ng/mL, limits of agreement within ± 2.0 ng/mL, and no fixed bias.

Conclusion: Dual single-lumen PICCs provide a safe and accurate method for tacrolimus monitoring in allo-HSCT, and may improve patient experience by reducing the need for painful venipuncture. Further randomized-controlled trials are needed to confirm the benefits of this approach and assess its applicability to the monitoring of other therapeutic agents.