Patient Selection Considerations:
Aquapheresis prescription is primarily based on the following patient criteria:

• Signs and symptoms of fluid overload
  • > 10 lbs over dry weight, dyspnea, edema
• Inadequate diuretic and/or natriuretic response
  • net fluid output < 125 cc/hr or 1,500 cc in 12 hours, net fluid output = urine output – fluid intake
• Exclusion of patients
  • In which venous access cannot be achieved, or requiring renal clearance (e.g. serum creatinine > 3.0, creatinine clearance < 15 cc/min)

Venous Access Catheters:

• CHF 6Fr. Dual lumen peripheral ELC, or
• CHF 5Fr. Single lumen peripheral ELC and 18G IV, or
• 7-8Fr. Dual lumen Central catheter

Refer to the Aquadex FlexFlow User’s Guide for catheter compatibility information. ELC = Extended Length Catheter.

Anticoagulation:
Follow standard heparin protocols (bolus or continuous) to achieve a minimum of 2 times normal levels (e.g. PTT 80-100, ACT 180-220)

Patients on coumadin are not usually given the initial bolus, but given levels following standard continuous infusion guidelines. If heparin is contraindicated, argatroban may be used. Low molecular weight heparin is not recommended.

Removal Rate:
The average removal rate is approximately 250 ml/hour.

Patients in volume sensitive states (e.g. right heart failure, pulmonary distress, hepatic disease, cardiogenic shock) usually require rates lower than the average (e.g. 50-150 ml/hour). Monitor patient for clinical signs of hypovolemia and hypotension as appropriate.

Duration:
The average treatment time is approximately 24 hours.