Complications of PORT-A-CATH® in patients with sickle cell disease

Alkindi, Salam; Matwani, Samaa; Al-Maawali, Alghalia; Al-Maskari, Buthaina; Pathare, Anil

doi:10.1016/j.jiph.2011.10.004

Cited by 33 publications

(36 citation statements)

References 19 publications

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“…23 Catheter-related venous thromboembolism was more likely to occur in patients with sickle cell anemia (SS/Sβ 0 ) genotypes, consistent with the high use of catheters for treatment in this subgroup. 23, 30 In contrast, we found that non-catheter-related venous thromboembolism was significantly more common in adult patients with sickle variant genotypes than in patients with sickle cell anemia. We suspect that increased whole blood viscosity may underlie this genotypic difference.…”

Section: Discussionmentioning

confidence: 57%

Venous Thromboembolism in Adults with Sickle Cell Disease: A Serious and Under-recognized Complication

Naik

Streiff

Haywood

et al. 2013

The American Journal of Medicine

171

141

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BACKGROUND Sickle cell disease is recognized as a hypercoagulable state; however the frequency and characteristics of venous thromboembolism in sickle cell patients have not been well-defined. PURPOSE To establish the prevalence and risk factors for venous thromboembolism in a large cohort of patients with sickle cell disease and determine the relationship between venous thromboembolism and mortality. METHODS We performed a cross-sectional study of 404 sickle cell disease patients cared for at the Sickle Cell Center for Adults at Johns Hopkins. Demographic, sickle cell disease-specific comorbidity, and venous thromboembolism data were collected on all patients. RESULTS 101 patients (25%) had a history of venous thromboembolism with a median age at diagnosis of 29.9 years. A history of non-catheter-related venous thromboembolism was found in 18.8% of patients. Sickle variant genotypes conferred a higher risk of non-catheter-related venous thromboembolism compared to sickle cell anemia genotypes (SS/Sβ0) (relative risk (RR) 1.77, 95% confidence interval (CI) 1.18–2.66). Tricuspid regurgitant jet velocity ≥ 2.5 m/s was also associated with non-catheter-related venous thromboembolism (RR 1.65, CI 1.12–2.45). Thirty patients (7.4%) died during the study period. Adjusting for all variables, non-catheter-related venous thromboembolism was independently correlated with death (RR 3.63, CI 1.66–7.92). CONCLUSION Venous thromboembolism is common in adults with sickle cell disease. Sickle variant genotypes and tricuspid regurgitant jet velocity ≥ 2.5m/s are associated with non-catheter-related venous thromboembolism. In addition, non-catheter-related venous thromboembolism appears to be an independent risk factor for death in our cohort. These results suggest that disease-specific prophylaxis and treatment strategies for venous thromboembolism should be investigated in sickle cell disease patients.

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Section: Discussionmentioning

confidence: 57%

Venous Thromboembolism in Adults with Sickle Cell Disease: A Serious and Under-recognized Complication

Naik

Streiff

Haywood

et al. 2013

The American Journal of Medicine

171

141

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“…Implantable ports are a well‐tolerated, long‐term option in patients expected to undergo regular exchanges because of a reduced care burden on the patient and infection rate (up to 10x less than central venous catheters) due to their subcutaneous placement . However, previous studies have reported an increased complication rate and decreased flow rates in comparison to temporary central venous catheters …”

Section: Introductionmentioning

confidence: 99%

“…7 However, previous studies have reported an increased complication rate and decreased flow rates in comparison to temporary central venous catheters. 8,9 Implantable ports generally have a body composed of a titanium, plastic, or silicone drum with an overlying selfsealing septum allowing for extended longevity if special noncoring needles are used. The body is attached to a central venous catheter which may be made of silicone or polyurethane.…”

mentioning

confidence: 99%

Indwelling ports for prophylactic RBC exchanges in sickle cell patients: Comparison of bard and vortex ports

Lawicki

Craig-Owens

Bream

et al. 2018

J of Clinical Apheresis

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Introduction Red blood cell exchange (RCE) procedures are commonly used for stroke prevention in sickle cell disease (SCD) patients. We compared two different dual lumen ports used for RCE because differences between the port and catheter design may lead to functional variance. Methods We reviewed the RCE parameters of SCD patients following implantable port placement encountered at a single institution. Five Vortex and four Bard ports were used and compared. Patients were followed for 1‐24 exchange procedures over 3‐26 months performed between 2013 and 2015. Results Nine patients underwent 124 RCE procedures with no failures. A total of 74 exchanges used Vortex ports with a mean flow rate of 45.2 mL/min while 50 exchanges used Bard ports with a mean flow rate of 42.1 mL/min which was a significant difference (P = .002). A total of 85 exchanges with tPA administration preprocedure had a mean flow rate of 43.8 mL/min while 39 exchanges without had a mean flow rate of 45.4 mL/min which was not a significant difference (P = .19). Conclusion Both the Bard and Vortex ports functioned well during our study period with no treatment failures, no significant complications requiring removal or replacement, and adequate mean flow rates. While the difference in mean flow rates was statistically significant between Vortex and Bard ports, there may not be a practical difference in performance. There also does not appear to be a significant benefit in flow rates with preprocedure tPA. We conclude that both ports may be a satisfactory choice for vascular access in SCD patients expected to undergo regularly scheduled RCE.

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“…6 Central venous access is often required for these modes, typically with an implanted infusion port, with potential risks including infection, thrombosis, and line malfunction. [7][8][9] There are limited data on complication rates associated with chronic transfusion therapy and central lines in children with SCD.…”

mentioning

confidence: 99%

Increased complications of chronic erythrocytapheresis compared with manual exchange transfusions in children and adolescents with sickle cell disease

Woods

Hayashi

Binkley

et al. 2017

Pediatric Blood & Cancer

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Complications of PORT-A-CATH® in patients with sickle cell disease

Cited by 33 publications

References 19 publications

Venous Thromboembolism in Adults with Sickle Cell Disease: A Serious and Under-recognized Complication

Venous Thromboembolism in Adults with Sickle Cell Disease: A Serious and Under-recognized Complication

Indwelling ports for prophylactic RBC exchanges in sickle cell patients: Comparison of bard and vortex ports

Increased complications of chronic erythrocytapheresis compared with manual exchange transfusions in children and adolescents with sickle cell disease

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