PB2317 CHOICE OF VENOUS ACCESS FOR CHRONIC RED CELL EXCHANGE IN CHILDREN WITH SICKLE CELL DISEASE

Background: Among the options of chronic transfusion regimen in sickle cell anemia (SCA), red cell exchange (RCE) is the most efficient method. In pediatrics, permanent venous accesses minimize venous punctions and improve the quality of life. Port‐a‐cath (PAC) are the devices with the least infectious complications. The recommended size of the PAC is related to the patient's age and weight Patients with SCA have a higher risk of thrombotic complications. Aims: Our objective is to select the most versatile and small PACs, to reduce thrombotic risk, which allow adequate flows to perform RCE. Methods: Selection of PAC marketed in Europe with one and two lumen, depending on the size of the reservoir, catheter, speed and availability in Europe Ex vivo analysis of the maximum flows tolerated by the ”Spectra Optia“ machine during the RCE procedure, using expired red blood cell concentrates and Gripper needles of 19 and 20G. Implantation of the device and analysis of the efficacy of the procedure in 2 patients with SCA in a chronic transfusion regimen for 2 years Results: After a first screening, the Cardiva PHS Medical 10.5fr double‐lumen PACs were analyzed; Bard 9.5 fr and Vortex Angyodinamics 11.4 fr. As a PAC of single lumen, the Smart Port CT mini Angyodinamics of 6.6 fr was analyzed, in order to use an extraction PAC and a return one for the same vessel. The catheters that showed better results were those of Angyodinamics, using Gripper of 19G and reaching flows of 25‐30 ml / min. Among these PACs, we selected the 6.6 fr of single lumen for the following reasons: smaller reservoir (more suitable for small and thin children), separate devices that allow only one of them to be replaced if a light is obstructed and because a Single‐light PAC could be sufficient if in the future Spectra Optima allows the unipuncture mode. In vivo, we successfully implanted the 2 PAC of single lumen selected in 2 patients of more than 40 kg, in which we were able to perform RCE every 6 weeks, during the last 2 years. The procedure is performed in an average of 3 hours. There have been no complications of thrombosis, obstruction or infection to date. Summary/Conclusion: The exvivo test allowed to discard devices not suitable for the procedure and to select a single lumen PAC model of 6.6 fr that allows sufficient flows to perform the chronic RCE in pediatric patients of any age and weight, minimizing the associated infectious and thrombotic risks to permanent accesses in patients with ACF.