Shrestha Anuj, Jawa Zeeshan, Koch Kathryn L, Rankin Amy B, Xiang Qun, Padmanabhan Anand, Karafin Matthew S, Field Joshua J
Department of Medicine, BloodCenter of Wisconsin, Milwaukee, Wisconsin.
Department of Biostatistics, BloodCenter of Wisconsin, Milwaukee, Wisconsin.
J Clin Apher. 2015 Dec;30(6):353-8. doi: 10.1002/jca.21393. Epub 2015 Mar 19.
Red cell exchange (RCE) is a common procedure in adults with sickle cell disease (SCD). Implantable dual lumen Vortex (DLV) ports can be used for RCE in patients with poor peripheral venous access. We performed a retrospective cohort study of RCE procedures performed in adults with SCD. The main objective of the study was to compare the inlet speed, duration of procedures and rate of complications performed through DLV ports to those performed through temporary central venous and peripheral catheters. Twenty-nine adults with SCD underwent a total of 318 RCE procedures. Twenty adults had DLV ports placed and 218 procedures were performed using DLV ports. Mean length of follow-up after DLV port placement was 397 ± 263 days. Six DLV ports were removed due to infection and 1 for malfunction after a mean of 171 ± 120 days. Compared to temporary central venous and peripheral catheters, DLV port procedures had a greater rate of procedural complications, a longer duration, and a lower inlet speed (all P < 0.01). When accounting for the maximum allowable inlet speed to avoid citrate toxicity, 40% of DLV port procedures were greater than 10% below maximum speed, compared to 7 and 14% of procedures performed through temporary central venous and peripheral catheters (P < 0.0001). In conclusion, DLV ports can be used for RCE in adults with SCD, albeit with more procedural complications and longer duration. The smaller internal diameter and longer catheter of DLV ports compared to temporary central venous catheters likely accounts for the differences noted.
红细胞置换（RCE）是镰状细胞病（SCD）成人患者的常见治疗手段。对于外周静脉通路不佳的患者，可使用植入式双腔Vortex（DLV）端口进行红细胞置换。我们对成年SCD患者进行的红细胞置换治疗进行了一项回顾性队列研究。该研究的主要目的是比较通过DLV端口进行的红细胞置换与通过临时中心静脉导管和外周导管进行的红细胞置换在输入速度、治疗持续时间和并发症发生率方面的差异。29名成年SCD患者共接受了318次红细胞置换治疗。20名患者植入了DLV端口，其中218次治疗使用了DLV端口。DLV端口植入后的平均随访时间为397±263天。6个DLV端口因感染被移除，1个因故障在平均171±120天后被移除。与临时中心静脉导管和外周导管相比，DLV端口治疗的手术并发症发生率更高、持续时间更长、输入速度更低（所有P<0.01）。在考虑避免柠檬酸盐毒性的最大允许输入速度时，40%的DLV端口治疗低于最大速度10%以上，而通过临时中心静脉导管和外周导管进行的治疗分别为7%和14%（P<0.0001）。总之，DLV端口可用于成年SCD患者的红细胞置换，尽管手术并发症更多且持续时间更长。与临时中心静脉导管相比，DLV端口内径较小且导管较长，这可能是导致上述差异的原因。
