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

Abstract

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.

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

“…Of note, there was a difference in the type of port placed for the pediatric group, who predominantly utilized the Bard 9.5F dual lumen port vs the adult group that primarily utilized the AngioDynamics 11.4F dual lumen port. However, consistent with another study that compared the Bard and AngioDynamics ports, there was little practical difference between the two ports as the larger port size in the adult cohort did not seem to provide enough additional flow to normalize the difference in flow requirements between the two cohorts 11 . When we plot the patients who successfully run at institutional default parameters (defined as running with an AC infusion rate of 1.1 mL/min/L TBV and WB:AC of 15:1 without decreasing inlet flow rate) by weight, the 75th percentile for a successful RBC exchange shows a cutoff of 57 kg with a maximum successful weight at 72 kg.…”

“…The overall experience with dual lumen ports at our institution in both the pediatric and adult sickle cell population suggests that this form of access is adequate in performing RBC exchange and consistent with similarly published studies 9‐11 . How adequacy is defined may differ amongst different programs, but adequacy in this context could reasonably be defined as expecting a RBC exchange procedure to be completed in less than 2 hours with procedural complications causing minor delays to occur in less than 10% of the total procedures.…”

“…This more aggressive use of TPA may be a key difference in why our reported rates of procedural complications are lower than those reported by others. Use of preprocedure TPA has not been shown to improve flow rates while using dual lumen ports, 11 but its frequent use may have a potential impact on the long term maintenance of the port and in turn minimize access alarms and delays. With regard to the frequency of adverse events between cohorts, we did not detect a difference between the pediatric and adult groups after accounting for non‐independent data due to clustering.…”

“…The overall experience with dual lumen ports at our institution in both the pediatric and adult sickle cell population suggests that this form of access is adequate in performing RBC exchange and consistent with similarly published studies. [9][10][11] How adequacy is defined may differ amongst different programs, but adequacy in this context could reasonably be defined as expecting a RBC exchange procedure to be completed in less than 2 hours with procedural complications causing minor delays to occur in less than 10% of the total procedures. In both pediatrics and adults, this threshold for adequacy was achievable in the majority of procedures using the dual lumen ports, although significant differences between the two groups with regards to run time and procedural complications would suggest that pediatric SCD patients can more easily achieve optimal run parameters using a dual lumen port than in adults.…”

“…The weight distribution for both groups is shown as a box plot with bars for minimum and maximum weight range requirements between the two cohorts. 11 When we plot the patients who successfully run at institutional default parameters (defined as running with an AC infusion rate of 1.1 mL/min/L TBV and WB:AC of 15:1 without decreasing inlet flow rate) by weight, the 75th percentile for a successful RBC exchange shows a cutoff of 57 kg with a maximum successful weight at 72 kg. For future cases and planning, it may be more practical to look at the weight of a patient rather than their age when deciding to place a dual lumen port.…”