{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T05:53:45Z","timestamp":1791179625375,"version":"4.1.0"},"reference-count":17,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T00:00:00Z","timestamp":1791072000000},"content-version":"vor","delay-in-days":3,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Clinical Apheresis"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    Peripheral intravenous catheters (PIVCs) are the preferred vascular access for apheresis; however, veins that initially appear suitable may develop venous spasms, resulting in poor inlet flow and frequent pressure alarms. Ports used for apheresis can also experience inlet pressure alarms due to catheter or venous occlusion. When conservative measures failed, we implemented a novel double\u2010draw technique in which a second draw line was connected via a four\u2010way stopcock and male\u2010to\u2010male adapter to the initial draw access (either a PIVC or port) to improve inlet flow. The double\u2010draw technique was performed in 26 procedures (therapeutic plasma exchange [TPE],\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u200910 and lipoprotein apheresis [LA],\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u200916) in 8 patients. During TPE, median negative inlet pressure improved from \u2212179\u2009mmHg (IQR \u2212218 to \u221269) with single\u2010draw access to \u221271\u2009mmHg (IQR \u221278 to \u221262) following placement of a second draw line (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.0162). Inlet flow rate during TPE improved from median 47\u2009mL\/min (IQR, 40\u201358\u2009mL\/min) with single\u2010draw access to 70\u2009mL\/min (IQR, 60\u201375\u2009mL\/min) (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.008). During LA, median negative inlet pressure improved from \u2212136\u2009mmHg (IQR \u2212193 to \u2212109) to \u221259\u2009mmHg (IQR \u221266 to \u221247) (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.0001). Median inlet flow rate during LA improved from 70\u2009mL\/min (IQR 59\u201371\u2009mL\/min) with single\u2010draw access to median 80\u2009mL\/min (IQR 70\u201380\u2009mL\/min) (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.023). Overall 25 of 26 procedures (96.2%) demonstrated an improvement in inlet pressure following implementation of the double\u2010draw technique. All procedures were completed successfully without abandonment of the original access site. The double\u2010draw technique is a novel option for managing inlet pressure alarms during apheresis when conservative measures fail.\n                  <\/jats:p>","DOI":"10.1002\/jca.70190","type":"journal-article","created":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T05:16:24Z","timestamp":1791177384000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Improving Apheresis Inlet Flow With a Novel Double\u2010Draw Vascular Access Technique"],"prefix":"10.1002","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5287-6472","authenticated-orcid":false,"given":"Amber P.","family":"Sanchez","sequence":"first","affiliation":[{"name":"Division of Nephrology and Hypertension, Department of Medicine University of California San Diego, Therapeutic Apheresis Unit  La Jolla California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dan Norman Nicodemus","family":"Perez","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension, Department of Medicine University of California San Diego, Therapeutic Apheresis Unit  La Jolla California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yeon Su","family":"Han","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension, Department of Medicine University of California San Diego, Therapeutic Apheresis Unit  La Jolla California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janice","family":"Park","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension, Department of Medicine University of California San Diego, Therapeutic Apheresis Unit  La Jolla California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marian","family":"Cabandong","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension, Department of Medicine University of California San Diego, Therapeutic Apheresis Unit  La Jolla California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jerel Lee S.","family":"Malong","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension, Department of Medicine University of California San Diego, Therapeutic Apheresis Unit  La Jolla California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,4]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"crossref","DOI":"10.1002\/jca.70141","article-title":"Guidelines on the Use of Therapeutic Apheersis in Clinical Practice\u2010Evidence Based Approach From the Writing Committee of the American Society for Apheresis: The Tenth Special Issue","author":"Zantek N. D.","year":"2026","journal-title":"Journal of Clinical Apheresis"},{"issue":"4","key":"e_1_2_12_3_1","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1053\/j.ajkd.2022.10.017","article-title":"Therapeutic Plasma Exchange: Core Curriculum 2023","volume":"81","author":"Cervantes C. E.","year":"2023","journal-title":"American Journal of Kidney Diseases"},{"issue":"5","key":"e_1_2_12_4_1","doi-asserted-by":"crossref","first-page":"711","DOI":"10.1002\/jca.21919","article-title":"Novel Use of a Midline Catheter for Therapeutic and Donor Apheresis in Children and Adults","volume":"36","author":"Casacchia C.","year":"2021","journal-title":"Journal of Clinical Apheresis"},{"issue":"4","key":"e_1_2_12_5_1","doi-asserted-by":"crossref","first-page":"694","DOI":"10.1111\/1744-9987.13799","article-title":"Vascular Access in Therapeutic Apheresis: One Size Does Not Fit All","volume":"26","author":"Golsorkhi M.","year":"2022","journal-title":"Therapeutic Apheresis and Dialysis"},{"issue":"3","key":"e_1_2_12_6_1","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1002\/jca.21778","article-title":"Peripheral Vascular Access for Therapeutic Plasma Exchange: A Practical Approach to Increased Utilization and Selecting the Most Appropriate Vascular Access","volume":"35","author":"Barth D.","year":"2020","journal-title":"Journal of Clinical Apheresis"},{"issue":"5","key":"e_1_2_12_7_1","doi-asserted-by":"crossref","first-page":"576","DOI":"10.1002\/jca.21643","article-title":"Choosing Wisely for Apheresis","volume":"33","author":"Connelly\u2010Smith L.","year":"2018","journal-title":"Journal of Clinical Apheresis"},{"issue":"2","key":"e_1_2_12_8_1","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1111\/j.1525-139X.2011.01024.x","article-title":"Vascular Access Considerations for Therapeutic Apheresis Procedures","volume":"25","author":"Okafor C.","year":"2011","journal-title":"Seminars in Dialysis"},{"issue":"51","key":"e_1_2_12_9_1","doi-asserted-by":"crossref","first-page":"580","DOI":"10.1111\/trf.14479","article-title":"Vascular Access for Therapeutic Plasma Exchange","volume":"58","author":"Ipe T. S.","year":"2018","journal-title":"Transfusion"},{"issue":"4","key":"e_1_2_12_10_1","doi-asserted-by":"crossref","first-page":"482","DOI":"10.1002\/jca.21678","article-title":"New Subcutaneous PowerFlow Port Results in Cost and Time\u2010Savings in a Busy Outpatient Apheresis Clinic","volume":"34","author":"Williams L. A.","year":"2019","journal-title":"Journal of Clinical Apheresis"},{"issue":"6","key":"e_1_2_12_11_1","doi-asserted-by":"crossref","first-page":"553","DOI":"10.1002\/jca.21508","article-title":"Is Peripheral Access for Apheresis Procedures Underutilized in Clinical Practice?\u2014A Single Center Experience","volume":"32","author":"Putensen D.","year":"2017","journal-title":"Journal of Clinical Apheresis"},{"issue":"6","key":"e_1_2_12_12_1","doi-asserted-by":"crossref","DOI":"10.1002\/jca.70079","article-title":"Real\u2010World Safety Data From the World Apheresis Association Registry for the Spectra Optia Apheresis System","volume":"40","author":"Haubner A.","year":"2025","journal-title":"Journal of Clinical Apheresis"},{"key":"e_1_2_12_13_1","article-title":"Defining Difficult Intravenous Access (DIVA): A Systematic Review","volume":"17","author":"Bahl A.","year":"2021","journal-title":"Journal of Vascular Access"},{"issue":"3","key":"e_1_2_12_14_1","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1016\/j.hrtlng.2020.01.009","article-title":"Defining Risk Factors Associated With Difficult Peripheral Venous Cannulation: A Systematic Review and Meta\u2010Analysis","volume":"49","author":"Rodriguez\u2010Calero M. A.","year":"2020","journal-title":"Heart & Lung"},{"issue":"3","key":"e_1_2_12_15_1","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1002\/jca.21780","article-title":"Ultrasound\u2010Guidance of Peripheral Venous Catheterization in Apheresis Minimizes the Need for Central Venous Catheters","volume":"35","author":"Soderstrom A.","year":"2020","journal-title":"Journal of Clinical Apheresis"},{"issue":"3","key":"e_1_2_12_16_1","doi-asserted-by":"crossref","DOI":"10.1002\/jca.70126","article-title":"Retrospective Evaluation of Dual Specialty Ports in Therapeutic Apheresis","volume":"41","author":"Swar\u2010Eldahab M.","year":"2026","journal-title":"Journal of Clinical Apheresis"},{"issue":"1","key":"e_1_2_12_17_1","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1007\/s002689900342","article-title":"Implantable Vascular Access Systems: Experience in 1500 Patients With Totally Implanted Central Venous Port Systems","volume":"22","author":"Kock H. J.","year":"1998","journal-title":"World Journal of Surgery"},{"issue":"2","key":"e_1_2_12_18_1","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1177\/1129729820932425","article-title":"Dual\u2010Chambered Venous Access Port as an Alternative Access for Extracorporeal Apheresis Therapy","volume":"22","author":"Michell H.","year":"2021","journal-title":"Journal of Vascular Access"}],"container-title":["Journal of Clinical Apheresis"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jca.70190","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/jca.70190","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jca.70190","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T05:16:26Z","timestamp":1791177386000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/jca.70190"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10]]},"references-count":17,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,10]]}},"alternative-id":["10.1002\/jca.70190"],"URL":"https:\/\/doi.org\/10.1002\/jca.70190","archive":["Portico"],"relation":{},"ISSN":["0733-2459","1098-1101"],"issn-type":[{"value":"0733-2459","type":"print"},{"value":"1098-1101","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10]]},"assertion":[{"value":"2026-08-26","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-28","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-04","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70190"}}