newsletters
Welcome to A Better Way, a newsletter published
by CHF Solutions, Inc.
Created for our community of physicians, nurses, administrators,
and patients who care about improving the care and outcomes of patients
suffering from fluid overload, this is YOUR newsletter, and our
goal is to provide a forum in which all of you can learn, interact
and share knowledge and experiences with one another.
What's
New
• 2 New Products Released. A new dual lumen
catheter to ensure steady and reliable blood flows in a
wide range of patients and the Hematocrit monitoring feature
that automatically limits the fluid removal rate.
• Ultrafiltration updated in the most recent ACC/AHA
Treatment Guidelines
• Patient Selection Screening tools developed
by St. Dominic’s Hospital. Developed to ID patients to maximize
benefits and minimize delay and costs
• Core Measure Outcome Results Questioned and Diuretic
Failure Explored
• New and streamlined Aquapheresis Order set template
is available. Replace your current orders with this new
version – it’s shorter, easier, and more helpful.
Product News
Coiled Dual Lumen Extended Catheter
The cdELC is a PERIPHERAL catheter that provides steady and reliable
blood flows in a wide range of patients. Its flexible, embedded
stainless steel coil resists kinking and minimizes disruptions to
therapy.
• “Single Stick", only 1 peripheral venous access
site required
• Blood flow up to 40 ml/min, fluid removal rates up
to 500 ml/hour
• 15 cm, 6 French, and reverse-tapered with offset
tip to minimize recirculation of blood
• Polyurethane, radiopaque, and latex-free
• PN: A1664
Hematocrit Monitoring
A feature on the Aquapheresis Aquadex FlexFlow™ device that
AUTOMATICALLY limits the fluid removal rate to help prevent volume
depletion due to high ultrafiltration rates and extended treatment
times.
• Provides enhanced patient monitoring and
prevents excessive volume removal
• Automatic and based on each individual's
hemodynamic response
• Simply enabled or disabled
• Feature included in all new devices and
available as an optional upgrade to existing
devices
Ultrafiltration Updated in ACC/AHA
Guidelines
Ultrafiltration is reasonable for patients with refractory congestion
not responding to medical therapy (Class IIa, Level of Evidence
B)
Aquapheresis is now ranked HIGHER in the LEVEL OF EVIDENCE than:
- salt restriction - strict I/Os
- initial IV diuretic dose = chronic oral daily dose - higher doses
and titration of loop diuretics
- addition of a second diuretic - continuous infusion of a loop
diuretic
- vasodilators such as IV nitroglycerin, nitroprusside, nesiritide
- IV inotropes
All of them are Level of Evidence: C.
For more info, go to http://content.onlinejacc.org/cgi/content/full/j.jacc.2008.11.009
Hospital Profile
– Saint Dominic-Jackson Memorial Hospital
Located in Jackson MS, Saint Dominic-Jackson Memorial Hospital
has offered Aquapheresis therapy to their patients with fluid overload
since early 2008.
To help further improve their patient outcomes, they looked inward
to their own processes to help streamline the delivery of care.
They specifically looked at ways to identify patients who would
most benefit from Aquapheresis earlier than later and developed
tools to help.
One simple yet powerful tool is a “Daily clinical pharmacy
report”. This report automatically produced by Case Management
and emailed to targeted physicians and nurses daily simply lists
the patients, their locations, what drugs (diuretics, inotropes),
what dose, admin route, frequency, and when started.
From this data, a simple algorithm was developed to ID patients
earlier who were not responding to standard care and who should
receive Aquapheresis. A key factor is if current diuretic dose =
80mg daily.
It really comes down to asking the following within the first 24
hours after admission: “Is the patient at dry weight? Are
the drug-based options failing? Let’s not waste any more time,
switch to Aquapheresis and get to dry weight”
This has allowed them to maximize the benefits to those who are
appropriate for AQ and to minimize delay and cost to their hospital
for failing to achieve the outcome and readmission goals for their
patients.
For more info, contact Ms. Buffy Ewing, 713-557-9120
Journal Club
Performance Measures and Outcomes: Real or Illusionary
Gains?
Fonarow GC. JAMA 2009;302(7):792-794.
A study on hundreds of thousands of Medicare patients shows that
the millions of dollars and countless hours spent on performance
measures are NOT providing outcome improvements.
Impact of Intravenous Loop Diuretics on Outcomes of Patients
Peacock et. al. Cardiology 2009;113:12-19.
Patients who receive = 160 mg of diuretic dose daily:
- have longer LOS,
- have higher mortality,
- have sCr rises of > 0.5,
- are 3 times more likely to receive dialysis
To learn more or to get a reprint or powerpoint slides, go to www.unloadstudy.com
Helpful Hints & Support
1. Your AQ Report
How is your AQ program doing? How many treatments? What’s
the avg treatment time, avg fluid removed, etc…
Do you want to know yours? Request a report from your local rep
today!
2. Online Presentations
We are proud to host a series on online presentations by Aquapheresis
experts. Topics include:
- Diuretic Failure
- Patient Prescription Criteria, Guidelines and Access
- Plasma Refill and UF Rate
- How We Use Aquapheresis in Our Hospital
Interested? Ask your local rep today!
Contact CHF with your tips & suggestions to share with your
fellow prescribers and users! info@chfsolutions.com,
www.chfsolutions.com,
763-463-4662
In the News!
- Visit http://www.chfsolutions.com/news
Lutheran Hospital in Fort Wayne Indiana
"The hospital readmission rate is substantially lower than
for those who continue with traditional diuretic treatment,"
said Dr. Mark A. Jones, Lutheran Hospital’s medical director
of heart transplant, ventricular assist devices, congestive heart
failure and cardiac rehab.
Mercy Heart Hospital in Des Moines Iowa
"We now have a new clinical tool that allows us to rapidly
and safely remove large amounts of salt and water from an overloaded
patient, while avoiding the potential adverse effects of high-dose
diuretic therapy.” said Dr. William Wickemeyer, cardiologist
with the Iowa Heart Center.
The Aquadex System is indicated for temporary (up
to 8 hours) ultrafiltration treatment of patients with fluid overload
who have failed diuretic therapy; and extended (longer than 8 hours)
ultrafiltration treatment of patients with fluid overload who have
failed diuretic therapy and require hospitalization. All treatments
must be administered by a healthcare provider, under physician prescription,
both of whom having received training in extracorporeal therapies.
L5166 Rev. B 10/09
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