Peripherally Inserted Veno-Venous Ultrafiltration for Rapid Treatment of Volume Overloaded Patients

Brian E. Jaski, MD, Jae Ha, BS,Bart G. Denys, MD, Sumant Lamba, MD,Robin J. Trupp, MSN, William T. Abraham, MDSan Diego, California; Thibodaux, Louisiana; Lexington, Kentucky

Journal of Cardiac Failure 2003 9(3);227-231.

Background: Veno-venous ultrafiltration may benefit patients with acute or chronic circulatory volume overload. Use of conventional systems, however, may be cumbersome, requiring physician placement of a double-lumen central venous catheter and use of a dedicated dialysis technician and apparatus.

Methods: A simplified peripheral ultrafiltration system including a miniaturized disposable circuit was evaluated in patients with volume-overload states. Separate intravenous catheters 16–18 G) for withdrawal and return of blood (blood flow ≤ 40 mL/min, ultrafiltrate ≤ 500 mL/h) were placed by non-physician personnel in upper extremity veins. Twenty-five treatments of up to 8 hours were performed in 21 patients.

Results: The primary endpoint of greater than 1 L fluid removal in less than 8 hours was achieved in 23 of 25 treatments. On average, 2611 ± 1002 mL (maximum 3,725 mL) of ultrafiltrate was removed per treatment (treatment period 6:43 ± 1:47 hours:minutes). Patient weight decreased from 91.9 ± 17.5 to 89.3 ± 17.3 kg (P < .0001) after ultrafiltration. No major adverse events occurred.

Conclusions: Rapid removal of extracellular and intravascular fluid volume excess can be safely achieved via peripherally inserted ultrafiltration without the need for central venous catheter placement.