Vascular access for red blood cell exchange

Section: Introductionmentioning

confidence: 99%

Vascular access practices for therapeutic apheresis: Results of a survey

Tanhehco

Zantek

Alsammak

et al. 2019

“…Vascular access options for RBC exchange include peripheral access, central venous catheters, implantable ports, and arteriovenous fistulae/grafts . Peripheral access is typically the preferred choice for RCE whenever possible because of the low complication rate; nevertheless, many patients undergoing regular exchanges may not tolerate repeated peripheral access due to discomfort or eventual loss of adequate veins. 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 .…”

Section: Introductionmentioning

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

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.

“…In the pediatric population, small patient size and difficulty in maintaining arms in position add to the challenge. Additional access options historically viable for RBC exchange include arterio‐venous fistulas, tunneled and non‐tunneled central lines rated for hemodialysis and implantable single lumen ports, all of which carry benefits but also limitations related to the performance of the procedure, impact on quality of life and risk of infectious and thrombotic complications 6‐8 . In recent years, the availability of dual lumen ports have prompted some institutions to trial them for use in RBC exchange.…”

Section: Introductionmentioning

confidence: 99%

“…Additional access options historically viable for RBC exchange include arterio-venous fistulas, tunneled and non-tunneled central lines rated for hemodialysis and implantable single lumen ports, all of which carry benefits but also limitations related to the performance of the procedure, impact on quality of life and risk of infectious and thrombotic complications. [6][7][8] In recent years, the availability of dual lumen ports have prompted some institutions to trial them for use in RBC exchange. Dual lumen ports have their limitations like other forms of central venous access, but allow the benefit of being less conspicuous with less risk for infectious complications than tunneled central venous catheters while also maintaining double needle automated apheresis flow in a single catheter.…”

Section: Introductionmentioning

confidence: 99%

Use of dual lumen ports for red blood cell exchange: A comparison of adults and children with sickle cell disease

Nizzi

Jamshidi

et al. 2020

Purpose Sickle cell patients receiving chronic RBC exchange require a form of long‐term central venous access if peripheral access is inadequate. In adults, dual lumen (DL) ports have been utilized but associated with greater procedure complications and duration when compared to other forms of access. In the pediatric sickle cell population, the use of DL ports for RBC exchange has not been well described. In this retrospective cohort study, RBC exchange procedures utilizing DL ports in the pediatric vs adult sickle cell population were compared. Methods Medical records were reviewed for 685 RBC exchange procedures performed on 25 patients (11 pediatric and 14 adult) between November 2014 to November 2018. Patient‐level characteristics and outcomes were compared between pediatric and adult patients using the Fisher‐exact and Wilcoxon‐rank sum test. Linear/logistic regression models examined procedure‐level parameters and port characteristics with adjustment for clustering. Results Compared to adults, pediatric patients had slower average maximum inlet speed (42 vs 53 mL/min, P < .01), but shorter procedure time (60 vs 75 minutes, P < .01) and lower rate of access alarms (1% vs 11%, P < .01). Overall, 0.29 thrombotic events per 1000 port days and 0.04 infections per 1000 port days were observed. Conclusion For adult and pediatric sickle cell patients, a DL port provides a viable option for RBC exchange. In comparison to adults, pediatric procedures with a DL port will typically be shorter and with less procedural complications due to smaller blood volumes and lower flow requirements.