Aquapheresis

[cardiacnurse05]

Our unit will soon be performing aquapheresis for treatment of Heart Failure. It was trialed in our CCU and will be coming to the floor. I was wondering if any other non-critical care units are doing this and how it is going.

[tbrnbsn]

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.

[Kardnurse]

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.

[CleioRN]

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!

[RN1989]

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.

[CleioRN]

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.

[PICCNURSE5392]

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

[tbrnbsn]

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.

[Chayo1989]

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.

[iluvivt, BSN, RN]

You need someone around that is great with venous access. PIVS can be troublesome as stated. What we do is that the IV Nurse places the single lumen Aquadex catheter (usually with ultrasound. The catheter should not be trimmed,otherwise you end up cutting off the two hole in the distal end of the catheter. Just leave some extra externally visible if needed. Also never use a stat loc on the aquadex catheter. (it pops is up enough to make the machine alarm off like crazy) The IV nurse then places a good 16 or 18 gauge. The company originally made a dual lume catheter.but is was too prblematic and last I heard they only have the single now...that why you need a catheter and a PIV,though you can do it with 2 GOOD pivs.

[grgshrk]

Aquapheresis therapy does exactly what the company states, "It removes fluid"

A Dual Lumen CVC that has 2 16gauge or larger ports will work 99% of the time no issue.

When you get into peripheral access for the therapy it works as well. However I would say that peripheral works 75% of the time with not issues. The company has come out with a new peripheral called the coil dual lumen extended length catheter. It is placed in the basilic vein and stops short of the shoulder. Just as most peripheral good placement is cruicial.

No matter what type of access you are using you should test it with the 10 in 10 test that the company recommends. This means you withdraw and flush both lumens with a 10cc syringe, you must get 10cc's in 10 seconds. If you cannot achieve this the line is not good enough. Have it repositioned or go with a different access location or catheter.

The study's all support Aquapheresis vs Diuretics in patients that are not responding well to diuretic therapy. Obviously you cannot use Aquapheresis if you do not have good access.

Alarms are caused by bad access, do yourself a favor and check the line before you use it.

Adios!

[NurseNina10]

i think that aquapheresis would be really beneficial for the population we serve... did anyone present this as a new treatment option in their hospital if so how did you go about researching aquapheresis and presenting it as a feasible/worth while treatment option for fluid overload?

[turnforthenurse, MSN, NP]

Very interesting, I haven't heard about this until now! I wonder why docs aren't using this treatment more.

What about using one of the 16G openings on a PICC line? I saw somewhere that an 18G would work, too...