success stories
 Chief
Complaint
Norma is a 54 year-old, former Marion General Hospital
ICU nurse, referred from the Infusion Clinic for admission due to
symptoms of increasing dyspnea, peripheral edema and hypotension.
History of Present Illness
She is well known to the cardiologists from previous
evaluations. Norma has a history of hospitalizations that average
an admission every 5 months, the latest being at the beginning of
June 2003. This hospitalization lasted approximately 5 days
with very little fluid removed using IV Lasix®, Natrecor®,
and a Primacor® drip.
Previous Medical History
On August 6, 2003, she presented at the Infusion Clinic
in a similar manner to her admission in June. Prior to this
admission, Norma has been taking Lasix® 80 mg b.i.d., Aldactone®
25 mg q.d., K-Dur® 10 mEq b.i.d., Digitek® 0.125 mg q.d.,
Darvocet®, Zaroxolyn®, Restoril® 30 mg q hs, Altace®
5 mg q.d., Coreg® 6.2 mg b.i.d., in addition to attending the
Infusion Clinic twice a week for Primacor® and the recently
added, Natrecor® infusions.
Norma has a history of hypertension, diabetes mellitus,
coronary artery disease, status-post coronary artery bypass grafting
in April 1994 with repeat bypass grafting due to graft occlusion
in March 2002. She has a history of ventricular arrhythmia
and is status-post automatic implantable cardioverter defibrillator
(AICD) implant. She was upgraded to a biventricular pacer
with AICD in June 2003.
Case Details
Her worsening condition required her admission to Marion
General Hospital and her treatment plan was unknown at the time
of her admission. She was showing signs of becoming refractory
to most medications. In April of 2003, Marion General began
evaluating the use of the Aquadex FlexFlow for fluid removal.
When Norma was admitted, it was clear that she would be a strong
candidate for use of the device. A venous catheter was placed
for blood withdrawal and an existing peripheral IV catheter was
used for infusion.
After spending 2 nights in the hospital and going
through two (2) Aquadex FlexFlow ultrafiltration treatments, Norma
was discharged from the hospital. With no clinically significant
effects to her hemodynamics or blood chemistry, a total of 9.75
liters of fluid was removed. Although this amount only represented
a portion of her excess fluid, Norma’s cardiologist believed
that by removing this initial bulk of fluid through ultrafiltration,
the kidneys would become more responsive to the medications and
diurese the remaining fluid. This theory was confirmed when
Norma called the hospital 3 days after the final treatment to report
that she did in fact void the remainder of the fluid. Norma
is scheduled to resume her visits to the Infusion Clinic where she
will be evaluated for continued maintenance therapy or for additional
ultrafiltration treatments with the Aquadex FlexFlow.
After her Aquadex FlexFlow treatments, Norma has
been responding well to her oral diuretics. In fact, her doses
have been cut in half to what they were prior to treatment.
She is currently prescribed Lasix® 40 mg b.i.d., Aldactone®
12.5 mg q.d., K-Dur® 10 mEq b.i.d., Digitek® 0.125 mg q.d.,
Darvocet®, Zaroxolyn®, Restoril® 30 mg q hs, Altace®
5 mg q.d., Coreg® 6.2 mg b.i.d.
Discussion
The nurses reported that the Aquadex FlexFlow is quite
simple to use. After seeing how effectively the device operates,
they are eager to use it to help more patients. More than
this, they are impressed by how stable the patient remains on the
device, the levels of monitoring it really requires, and the immediate
improvements to the patient’s fluid overloaded condition with
a reduction of symptoms. Norma would have to agree.
As the treatments began, she soon stated that her breathing had
improved and she could now lean over, bend her legs, and put her
socks and slippers on. Upon admission, she was unable to lift
or bend her legs to get into the car without assistance. Norma
summed up her feelings in the following quote:
“As a former ICU nurse, I have taken care
of patients in the same condition that I am now. I never dreamed
I would be the patient. After one treatment, my abdomen went
way down, I was able to bend my legs to sit in a chair, and my breathing
became so much better. The difference in how I feel, in such
a short period of time, is remarkable.”
- Norma, August 8, 2003
Case history courtesy of:
Kevin Kannan, M.D.
Smith Clinic
Marion, OH back to success stories
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