Strategies to Aid Identification of Apheresis PowerFlow Ports: A Case Report.

INTRODUCTION: The PowerFlow implantable apheresis intravenous port is a venous access device for therapeutic apheresis procedures. In this case review article, we identify key similarities and differences between apheresis PowerFlow ports and traditional ports. We also list strategies that emergency departments can implement to aid in correct port identification. METHODS: Using a case review format, we describe the clinical presentation of a 33-year-old female with neuromyelitis optica who was evaluated in the emergency department for an acute exacerbation. She had a history of outpatient apheresis procedures that made use of bilateral PowerFlow ports. Mistaken for a conventional port, the right PowerFlow port was accessed with a Huber needle rather than the appropriate catheter-over-needle device. On infusion of intravenous fluids, the patient experienced pain and swelling. Ultimately, the port malfunctioned and was eventually replaced. RESULTS: A subsequent root cause analysis identified opportunities for education and aids to improve port identification. To this end, strategies were implemented to appropriately identify the PowerFlow port using at least 2 of the following methods: (1) look in the patient's chart for record of an implantable apheresis intravenous port; (2) check the port identification card, bracelet, or keychain issued at insertion; (3) palpate the port to look for the rounded top and hollow concave entry point; and (4) use x-ray or fluoroscopy to identify radiopaque port markers. CONCLUSION: When a patient with a history of apheresis procedures presents with an implanted port, steps should be taken to ensure correct identification and access.

Therapeutic white blood cell and platelet depletions using the spectra OPTIA system continuous mononuclear cell protocol.

The Spectra Optia apheresis system has only recently been approved by the Food and Drug Administration (FDA) for therapeutic white blood cell (WBC) depletions and is not yet approved for platelet depletions. Prior to FDA-approval of the WBC depletion protocol, when our available COBE Spectra apheresis systems were out of service, we successfully performed WBC depletion using a modified Spectra Optia apheresis system Continuous Mononuclear Cell (CMNC) protocol. Using this modified Spectra Optia CMNC protocol, we created institutional protocols for WBC and platelet depletions. We performed 10 WBC depletions in 9 patients and 2 platelet depletions in 2 patients. We compared pre- and post-procedure WBC, platelet count, and hemoglobin to the same data from patients previously treated on the COBE Spectra and found no difference in % WBC and platelet reduction. We also found no significant difference in post-procedural hematocrit decline. Additionally, adverse reactions were not increased. Therefore, we conclude that the Spectra Optia CMNC protocol can be successfully modified for effective WBC and platelet depletions without increase in adverse reactions.

A retrospective study of complications of therapeutic plasma exchange in myasthenia.

INTRODUCTION: Venous access for therapeutic plasma exchange (TPE) in myasthenia gravis (MG) can be achieved by central venous catheters (CVC) or peripheral veins (PV), and the preferred method varies among providers. We evaluated our institutional experience with TPE venous access method and complications. METHODS: We reviewed all TPE-treated MG patients (2005-2010) through blinded chart review. TPE complications were categorized as serious or minor. Serious complications ended the procedure and/or were potentially life-threatening. RESULTS: A total of 134 MG patients received 230 TPE courses; 56% were outpatient procedures. Whenever feasible, TPE was performed by PV access, which was successful in 75% of courses. Over 90% in both groups improved after TPE. Compared with PV access, CVCs were associated with more total (68% vs. 35%) and serious complications (41% vs. 4%), including 2 deaths. CONCLUSIONS: PV access for TPE can be used successfully in most MG patients and may reduce morbidity of the procedure.