Goals
of Therapy:
Fluid reduction (decongestion), symptom relief, and the attainment
of euvolemia (dry weight).
Patient Selection Considerations:
Aquapheresis prescription is based on its indication for use
and usually 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:
The following are the most
common and recommended:
- 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.
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