Lawicki Shaun, Craig-Owens Laura, Bream Peter R, Eichbaum Quentin
Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee.
Department of Radiology and Radiologic Sciences, Vanderbilt University Medical Center, Nashville, Tennessee.
J Clin Apher. 2018 Dec;33(6):666-670. doi: 10.1002/jca.21663. Epub 2018 Nov 2.
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.
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.
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).
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.
红细胞置换（RCE）程序常用于镰状细胞病（SCD）患者的中风预防。我们比较了用于RCE的两种不同双腔端口，因为端口和导管设计的差异可能导致功能差异。
我们回顾了在单一机构遇到的植入端口放置后SCD患者的RCE参数。使用并比较了五个Vortex端口和四个Bard端口。在2013年至2015年期间，对患者进行了3至26个月的随访，共进行了1至24次置换程序。
9名患者接受了124次RCE程序，无失败病例。总共74次置换使用Vortex端口，平均流速为45.2毫升/分钟，而50次置换使用Bard端口，平均流速为42.1毫升/分钟，差异有统计学意义（P = .002）。总共85次在置换前使用tPA的置换平均流速为43.8毫升/分钟，而39次未使用tPA的置换平均流速为45.4毫升/分钟，差异无统计学意义（P = .19）。
在我们的研究期间，Bard和Vortex端口功能均良好，无治疗失败，无需要移除或更换的重大并发症，且平均流速充足。虽然Vortex和Bard端口的平均流速差异有统计学意义，但在性能上可能没有实际差异。置换前使用tPA在流速方面似乎也没有显著益处。我们得出结论，对于预期要定期进行RCE的SCD患者，这两种端口都可能是血管通路的满意选择。
