Aquapheresis

i am glad you let us know about the iv access issues. we are going to start the procedure soon and we will be using the same equipment from the same company. i will talk to my nephrologist and find a answer to your question. we will be doing the procedure on an outpatient basis. our center is in a venous access building, so the interventional nephrologists may have an answer. i will get back to you if i get a solution to the iv access problem

Thank you CardiacNurse05 and tbrnbsn for posting on this. They trained all our nurses in Cardiac stepdown back in January 2008. We have the Aquadex machine and the equipment even special easy to use order sheets but so far no doctor will order it. I wondering about that IV access, when you do dialysis you use huge av grafts, fistulas or Udalls, etc. all with huge lumens. But you can do aquapheresis with what is it, an 18g??- now I even forgot what gauge it is.

i have not done the procedure yet, but the company i work for uses pheresis needles. i think that they are 18 gauge. i have a meeting with some interventional nephrologists and the md who has done alot of aquapheresis this month. i will find out about iv access and get back to you all.

I work specifically with CHF pts. and we've been using ultrafiltration for awhile now.

I really haven't had any of the negative experiences that are posted in this thread nor have I heard of any. In general, as long as you use a large bore catheter (we use Quintons) you won't have a problem. The amount of fluid taken off is incredible, far better than a Lasixs gtt hands down. Our cardiologists have come on board, I think in part due to the fact that we have a dedicated area in our hospital to HF pts and we have a dedicated cardiologist that's very positive about UF.

Anyway, that's my experience so far. Hope this helps.

In my hospital in Georgia we began a stong aquaphoresis or ultrafiltration program. true the machines alarm a lot, but its usually for a very good reason and one that should be attended to. The machines are awesome in their simplicity as far as pt outcome is concerned. Remarkable results with no adverse effects on the patients. Electrolytes stay put (really! no flucuation with pounds and pounds of fluid taken off!) We have seen CHF pts get to dry weights we didn't know they had. They feel better, faster, and stay out of the hospital longer. It is very imtimidating at first when you are getting to know the machines and the ELC (extended length catheters) are a bit to master. We had our PICC line team inserting them and they worked well with a #18 gauge peripheral.
PM me if you have more questions.I think this therapy is great though and would love to see it catch on! our Cardiologists really signed onto it so that is a great help! Good luck!

This all sounds fascinating but I don't see this as something feasible to be done on the floor. Not unless you've got a ratio of only 3-4:1 with strong CNA backup to take care of the rest of the patietns when you have this going on.

We did it without a real problem with a 4:1 ratio on a Cardiac tele floor. It took some extra effort but that could be any of your patients in a given day. One thing to remember...its not dialysis or a machine that uses a dialysate. Its a simple filter system that only removes water and sodium. Therefore removing the fluid from the body. As the concentrated blood returns to the patient it helps to pull excess fluid back into the vascular. Simple and so good for the patients.

I am part of a PICC team that will start placing the dual lumen dELC catheter by CHF solutions. Do you use an ultrasound and microintroducer technique to insert this catheter? If so whose microintroducer kit do you use? DOes your PICC team exchange them out for a midline or PICC after the ultrafiltration is completed? How many days do you see the dELC catheter lasting? Ellen

we will be placing the elc cath for just the aquapheresis procedure. this is an out patient procedure. the line gets pulled when the tx is complete. the introducer we have is from bard. we do not use ultrasound.

Our hospital started using aquapheresis for about a year now. I've taken care of 3 patients on it.
The IV access is the biggest challenge. We have gone from peripheral lines to central lines thinking central lines may work better, but how wrong we were.
The last patient I had IV therapy placed the CHF Solutions dual lumen IV access port and that seemed to work pretty well. The only downside was the site oozing as the catheter size is pretty big and the patient is usually on a heparin drip.
The other thing that I've noticed is that patient's BUN/Cr usually trend up after aquapheresis.
Only two cardiologists are ordering this therapy, so it does make you wonder why others hesitate.
This therapy defenitely needs to be tweeked.