High-Flow Vascular Access in Apheresis: Why the Right Port Access Needle Matters
High-flow vascular access in apheresis is an important consideration for specialist Haematology and Apheresis teams because these procedures can place very different demands on vascular access compared with conventional infusion therapy.
Whether a patient is undergoing automated red cell exchange, therapeutic plasma exchange or the collection of cellular therapy products, an effective procedure depends on establishing and maintaining vascular access capable of supporting the required blood flow.
For Apheresis nurses, Haematology teams and Vascular Access specialists, the choice of access route, implanted port and compatible port access needle can therefore influence the practical management and efficiency of treatment.
Why Is Vascular Access So Important in Apheresis?
Apheresis involves withdrawing blood from a patient and passing it through specialist equipment. Depending on the procedure, particular components of the blood are separated, collected, exchanged or removed before the remaining components are returned to the patient.
NHS Blood and Transplant provides therapeutic apheresis services covering procedures including plasma exchange, automated red cell exchange and stem cell collection.
Further information is available from NHS Blood and Transplant:
Therapeutic apheresis – NHS Blood and Transplant
Because blood needs to move from the patient into an apheresis system and subsequently return, vascular access must be capable of supporting the requirements of the particular procedure.
Inadequate vascular access may contribute to flow problems, interruptions or difficulties completing treatment efficiently. This makes vascular access planning an important part of the wider apheresis pathway rather than simply a consideration at the point when a needle is inserted.
The British Society for Haematology guideline covering therapeutic apheresis also discusses vascular access options, including peripheral access, central access and implantable ports suitable for selected apheresis applications.
British Society for Haematology guideline:
What Vascular Access Is Used for Apheresis?
There is no single vascular access solution appropriate for every patient undergoing apheresis. Selection depends on the clinical procedure, required blood flow, quality of the patient’s peripheral veins, frequency of treatment, patient age and size, previous access history and other individual clinical factors.
Peripheral venous access may be appropriate for many patients and can avoid the need for an indwelling device. However, repeated apheresis presents different challenges, particularly when peripheral venous access is difficult or has deteriorated over time.
In these circumstances, specialist teams may consider alternative approaches, including temporary central venous access or an appropriate implanted vascular access port.
The decision must be based on an individual clinical assessment and the specific requirements of the procedure. Importantly, an implanted port should not automatically be assumed to be suitable for apheresis simply because it can be used for conventional infusion therapy.
High-Flow Vascular Access in Apheresis for Long-Term Treatment
The requirements associated with high-flow vascular access in apheresis become particularly relevant for patients receiving repeated or long-term procedures.
Automated red cell exchange is one example.
NHS Blood and Transplant explains that red cell exchange can be used for conditions affecting red blood cell function, including sickle cell disease. During the procedure, red cells are removed and replaced using specialist apheresis equipment.
Further information can be found here:
Therapeutic apheresis treatments – NHS Blood and Transplant
University College London Hospitals NHS Foundation Trust also explains that automated red cell exchange requires excellent blood flow. Where peripheral access is not possible, options can include deeper venous access, temporary central access or, for appropriately selected patients, a specialist implanted port.
UCLH provides further information here:
This demonstrates why access planning can become particularly important for patients enrolled in regular treatment programmes.
Implantable Ports and Apheresis
Implanted vascular access ports can provide an alternative for appropriately selected patients requiring repeated vascular access. However, apheresis introduces specific requirements that mean conventional implanted ports are not automatically appropriate.
The British Society for Haematology guideline notes that most implanted ports are unsuitable for apheresis and that only ports suitable for the intended apheresis application should be used.
This distinction is important.
The port must be considered alongside the needle, apheresis equipment, required flow characteristics and the manufacturer’s instructions for use. The complete access system needs to be suitable for its intended application.
Specialist knowledge is also important because implanted vascular access devices require appropriate care and management to maintain function and minimise complications such as infection, malfunction or access difficulties.
Why Does the Port Access Needle Matter?
An implanted vascular access port incorporates a septum that is accessed using an appropriate non-coring needle.
Unlike a conventional needle, a non-coring or Huber-style needle is designed to penetrate the septum without cutting out a core of material from it. This is important for maintaining the integrity of a port designed for repeated access.
For conventional infusion therapy, however, flow requirements may be considerably different from those encountered during specialist apheresis.
Selecting a needle simply because it is described as a non-coring or Huber needle is therefore not sufficient to establish that it is suitable for a high-flow application.
Clinical teams need to consider factors such as gauge, needle length, design, required flow, port compatibility, patient anatomy and the instructions supplied by the manufacturers of the relevant devices.
A 16G needle, for example, has a different internal diameter and potential flow characteristics from a smaller-gauge needle. Needle length is also significant because an appropriate length must be selected to access the implanted port correctly for the individual patient.
The port access needle should consequently be considered as part of the overall vascular access system.
Tidal™ High-Flow Non-Coring Needles
The Tidal™ High-Flow Non-Coring Needle range from Norfolk Medical has been developed for high-flow port access applications.
The range includes 16G and 18G options, with needle lengths of ¾ inch, 1 inch and 1¼ inch. This provides clinicians with different configurations when considering the requirements of individual patients and compatible implanted access systems.
The needles also incorporate a low-profile hub and colour coding for identification.
The appropriate configuration should always be determined by trained healthcare professionals with reference to the intended procedure, patient requirements, implanted port, local clinical protocols and applicable manufacturer instructions.
Niche Healthcare provides further information on 16G high-flow non-coring needles for Apheresis and Haematology teams here:
16G High-Flow Non-Coring Needles for Apheresis & Haematology
Healthcare teams reviewing wider vascular access requirements may also find information on the Niche Healthcare Venous Pro Vein Finder here:
Venous Pro Vein Finder – Niche Healthcare
Information on Niche Healthcare’s Safety Cannula IV Catheter range is available here:
Safety Cannula IV Catheter – Niche Healthcare
Automated Red Cell Exchange
Automated red cell exchange is an important area in which reliable vascular access may be required.
During an automated exchange, an apheresis machine removes red blood cells from the patient’s circulation and replaces them with donor red blood cells while returning other blood components.
For some patients with sickle cell disease, exchanges may form part of a long-term treatment programme. UCLH notes that some patients receiving long-term automated red cell exchange may have procedures every four to eight weeks.
Repeated vascular access over this period makes preservation and management of suitable access an important consideration.
Where reliable peripheral access cannot be achieved, a specialist team may assess whether another access method is clinically appropriate.
Therapeutic Plasma Exchange
High-flow access can also be relevant to therapeutic plasma exchange.
During plasma exchange, blood is processed so that plasma can be removed and replaced with an appropriate replacement fluid while the required cellular blood components are returned to the patient.
NHS Blood and Transplant provides therapeutic plasma exchange for patients across several clinical specialities, including Neurology, Renal Medicine and Haematology.
As with other apheresis procedures, the vascular access solution must be appropriate for the clinical procedure and capable of supporting the intended treatment safely and effectively.
Stem Cell and Cellular Therapy Collection
Apheresis is also central to the collection of peripheral blood stem cells and other cellular therapy products.
As cellular therapies continue to develop, specialist apheresis services play an increasingly important role in collecting the cells required for treatment and manufacturing pathways.
These procedures reinforce the importance of assessing vascular access early and selecting an appropriate strategy based on the patient’s veins, treatment requirements and expected flow.
A reliable access pathway can help specialist teams plan procedures efficiently while reducing the likelihood of access-related disruption.
Safety, Hygiene and Sharps Management
Although flow characteristics are important, vascular access decisions must always be considered alongside infection prevention, safe clinical practice and sharps management.
Needles are medical sharps and must be handled, used and disposed of according to appropriate clinical policies and regulatory requirements.
The Health and Safety Executive explains that the Health and Safety (Sharp Instruments in Healthcare) Regulations apply to healthcare employers and are intended to help prevent injuries to healthcare workers caused by medical sharps.
HSE guidance is available here:
The HSE also advises that sharps should be appropriately risk assessed, staff should receive relevant training, and used needles should be disposed of immediately into an appropriate sharps container rather than being reused, re-sheathed or routinely recapped.
Further HSE information is available here:
Avoiding needlestick or sharps injuries – HSE
For port access specifically, healthcare professionals should also follow local infection prevention procedures and the instructions for the port and needle being used.
Selecting the Appropriate High-Flow Port Access Solution
When a patient requires repeated apheresis, the vascular access strategy should be considered as part of their wider treatment pathway.
Teams may need to assess whether peripheral access remains consistently achievable, what blood flow the procedure requires, how frequently treatment will occur and whether an implanted access device is appropriate.
Where an implanted port is being used or considered, compatibility becomes particularly important. Teams should establish whether the particular port is suitable for the intended procedure and which non-coring needle specifications are recommended.
Gauge and length should not be selected in isolation. They form part of a wider clinical decision involving the patient’s anatomy, the implanted port, procedure requirements and device instructions.
This is why specialist high-flow needles should not simply be treated as interchangeable versions of conventional port access needles.
Supporting Apheresis, Haematology and Vascular Access Teams
Niche Healthcare works with healthcare professionals and organisations looking for specialist medical products and vascular access solutions.
For teams evaluating Tidal™ High-Flow Non-Coring Needles, Niche Healthcare can provide further information regarding available 16G and 18G configurations, needle lengths and relevant technical product information.
Product selection should remain a clinical decision made by appropriately trained professionals. Compatibility with the specific implanted port, apheresis system and intended clinical application should always be confirmed before use.
Frequently Asked Questions
What is a high-flow non-coring needle?
A high-flow non-coring needle is a specialist port access needle intended for use with a compatible implanted vascular access port where higher flow characteristics may be required. The suitability of a particular needle depends on the port, procedure, gauge, needle length and manufacturer instructions.
What sizes are Tidal™ High-Flow Non-Coring Needles available in?
Tidal™ High-Flow Non-Coring Needles are available in 16G and 18G options, with ¾ inch, 1 inch and 1¼ inch needle lengths. The appropriate configuration should be selected by the clinical team according to the patient, port and procedure requirements.
Can implanted ports be used for apheresis?
Certain implanted ports can form part of an apheresis access strategy for appropriately selected patients, but not every implanted port is suitable. British Society for Haematology guidance emphasises that only ports appropriate for apheresis should be used and that specialist knowledge is required for their management.
Why is blood flow important during apheresis?
Blood must be withdrawn from the patient, processed through an apheresis machine and returned. Appropriate vascular access therefore needs to support the flow required for the specific procedure. Poor or inadequate access can potentially contribute to treatment interruptions and difficulties maintaining the intended procedure.
Are high-flow needles relevant to automated red cell exchange?
They can be relevant when an appropriately selected patient undergoes automated red cell exchange using a compatible implanted vascular access port. The needle and port must be suitable for the intended application, and selection should be based on specialist clinical assessment and manufacturer instructions.
Who should assess vascular access for an apheresis patient?
Vascular access should be assessed by appropriately trained healthcare professionals familiar with the patient’s clinical requirements and the apheresis procedure. Decisions should take account of local policies, patient-specific considerations and the instructions for all devices involved.
Conclusion
High-flow vascular access in apheresis is an important part of planning and delivering specialist procedures such as automated red cell exchange, therapeutic plasma exchange and cellular therapy collection.
For patients who can no longer reliably use peripheral venous access, appropriately selected implanted vascular access devices may provide an alternative. However, the port itself is only one part of the system.
The non-coring needle used to access the port must also be appropriate for the intended high-flow application. Gauge, length, flow requirements, port compatibility, patient anatomy, infection prevention and safe sharps management all need to be considered as part of an individual clinical assessment.
Tidal™ High-Flow Non-Coring Needles provide 16G and 18G options across several needle lengths for specialist high-flow port access requirements. Healthcare professionals considering these products should ensure that the selected configuration is compatible with the implanted port and intended procedure and is used in accordance with applicable clinical protocols and manufacturer instructions.
Niche Healthcare can provide Apheresis, Haematology and Vascular Access teams with further product and technical information to support evaluation and procurement of suitable high-flow port access solutions.
High-Flow Vascular Access in Apheresis
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