Apheresis Ports: The Houston Methodist Experience. (21st September 2018)

• Record Type: Journal Article
• Authors: Ipe, Tina; Leveque, Christopher; Salazar, Eric
• Is Part Of: American journal of clinical pathology. Volume 150(2018)Supplement 1
• Page Start: S167
• Page End: S168
• Publication Date: 2018-09-21
• Subjects: Diagnosis, Laboratory -- Periodicals; Pathology -- Periodicals; 616.07
• DOI: 10.1093/ajcp/aqy112.386
• Languages: English
• ISSNs: 0002-9173

Abstract

Abstract: Background: Therapeutic apheresis cannot be performed without adequate vascular access and the ability to achieve inlet flow rates of approximately 50 to 100 mL/min. Central venous catheters (CVCs), which are dialysis capable, are intravascular devices used in apheresis and are capable of such performance. However, their use has several associated risks that include localized and systemic infections, as well as catheter occlusions and thrombosis. Some of these risks can be mitigated if peripheral venous access can be established. However, in some patients, peripheral vascular access is not an option for long-term apheresis treatments. In such situations, totally implantable venous access systems or ports are increasingly being utilized for vascular access. Ports offer several perceived advantages over CVCs, including low rates of infection, long-term usage, patient comfort, and improved quality of life. Methods: We recently sought to evaluate implantable ports in our apheresis patient population. Houston Methodist Hospital's apheresis service is a large, 2, 000-bed community and tertiary care system that performs approximately 3, 400 apheresis procedures per year. We collected data on two apheresis ports, the TidalPort (Norfolk Medical Products) and the PowerFlow (Bard Peripheral Vascular). The construction of these two ports is different; the TidalPort is cylindrical while the PowerFlow is funnel shaped. Given these design differences, we reviewed the safety and efficacy of these ports for long-term apheresis care. Results: In our apheresis population during 2016 to current, four patients were implanted with the TidalPort and four patients were implanted with the PowerFlow. For patients with the TidalPort, most of the complications were classified as grade 3 according to the WAA classification of apheresis adverse events (AEs). That is, in all patients with the TidalPort (four of four), there was an interruption of the procedure due to poor flow rates or catheter occlusions at the start of the procedure. Poor flow rates triggered multiple inadequate flow alarms. In patients with the PowerFlow, three of four patients had grade I AE, that is, they tolerated the procedure without medications. One of the four patients had a grade III AE, which necessitated port removal. No infection was noted in all eight ports. Conclusions: Ports are an option for long-term apheresis treatments and are a good alternative to CVCs. More severe complications were noted with the TidalPort in comparison to the PowerFlow. Further studies are needed to determine whether these ports have fewer complications than CVCs in our apheresis population.