UNC School of Medicine, Chapel Hill, North Carolina, USA.
Medical Resident, Emory University School of Medicine, Atlanta, Georgia, USA.
J Clin Apher. 2024 Aug;39(4):e22143. doi: 10.1002/jca.22143.
In patients with a need for frequent but intermittent apheresis, vascular access can prove challenging. We describe the migration of the use of a Vortex LP dual lumen port (Angiodynamics, Latham, NY) to one Powerflow and one ClearVUE power injectable port (Becton Dickinson, Franklin Lakes, NJ) in a series of patients undergoing intermittent apheresis.
All patients had a need for long-term intermittent apheresis. Eight had double lumen Vortex port (pre) and were exchanged for one Powerflow port and one conventional subcutaneous venous port with 90° needle entry (post) while 12 did not have any port in place and received the same configuration. IRB approval was granted. We recorded the treatment time, flow rate, and tissue plasminogen activator (tPA) use for five treatment sessions after placement. When available, we compared five treatments with the Vortex port and the new configuration.
The mean treatment time is reduced with the new configuration (P = 0.0033). The predicted mean treatment time, adjusting for gender, race, BMI and age and accounting for correlations within a patient is 91.18 min pre and 77.96 min post. The flow rate is higher with the new configuration (P < 0.0001). The predicted mean flow rate in mL/min is 61.59 for the Vortex port and 71.89 for the new configuration. tPA use was eliminated in the population converted from Vortex ports and had a 48% reduction when compared to all other configurations in the study.
The introduction of a novel device configuration of venous access ports for intermittent apheresis resulted in higher flow rates and less total time for treatment. Use of tPA was greatly reduced. These results suggest that the new configuration could result in less expense for the hospital and better throughput in a busy pheresis practice. Clinical trial registration with ClinicalTrials.gov: NCT04846374.
在需要频繁但间歇性血液分离的患者中，血管通路可能具有挑战性。我们描述了在一系列接受间歇性血液分离的患者中，将 Vortex LP 双腔端口（Angiodynamics，Latham，NY）的使用迁移到一个 Powerflow 和一个 ClearVUE 可注入电源端口（Becton Dickinson，Franklin Lakes，NJ）的情况。
所有患者均需要长期间歇性血液分离。8 例患者有双腔 Vortex 端口（术前），并更换为一个 Powerflow 端口和一个带有 90°针入口的常规皮下静脉端口（术后），而 12 例患者没有任何端口，接受相同的配置。获得了 IRB 批准。我们记录了放置后五个治疗疗程的治疗时间、流速和组织纤溶酶原激活剂（tPA）的使用情况。在有条件的情况下，我们将五个治疗疗程与 Vortex 端口和新配置进行了比较。
新配置的治疗时间明显缩短（P = 0.0033）。调整性别、种族、BMI 和年龄，并考虑到患者内的相关性后，预测的平均治疗时间，术前为 91.18 分钟，术后为 77.96 分钟。新配置的流速更高（P < 0.0001）。Vortex 端口的预测平均流速为 61.59mL/min，新配置的流速为 71.89mL/min。在转换为 Vortex 端口的人群中，tPA 的使用被消除，与研究中的所有其他配置相比，tPA 的使用减少了 48%。
引入新型间歇性血液分离静脉通路装置配置可提高流速并缩短总治疗时间。tPA 的使用大大减少。这些结果表明，新配置可能会降低医院的费用，并提高繁忙的血液分离实践中的吞吐量。在 ClinicalTrials.gov 上进行了临床试验注册：NCT04846374。
