Methods
Peripherally inserted veno-venous ultrafiltration for rapid treatment of volume overloaded patients*,**

Presented, in part, at the Heart Failure Society of America 6th Annual Scientific Meeting, 2002, Boca Raton, FL.
https://doi.org/10.1054/jcaf.2003.28Get rights and content

Abstract

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 nonphysician 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.

Section snippets

Study patients

A total of 25 treatments in 21 adult patients (15 men and 6 women, mean age 62.7 ± 16.3 years, mean height 175.6 ± 12.8 cm) with fluid overload were performed at 3 clinical sites. Fluid overload was identified if 2 or more of the following were present: (1) evidence of peripheral edema (≥2+), (2) ascites or enlarged liver, (3) rales one quarter up from base or paroxysmal nocturnal dyspnea or orthopnea, or (4) evidence of sacral edema (≥2+). All patients (n = 21) had a previous history of

Results

Of 25 treatments, 23 (92%) achieved the primary endpoint of greater than 1 L of ultrafiltrate removed, and 19 treatments (76%) removed more than 2 L (Fig. 2).

. Frequency versus fluid volume removed. Distribution of fluid volume removed in 25 treatments of ultrafiltration. The treatment ended at either the maximum of 8 hours of ultrafiltration system use or when removal of sufficient fluid for symptomatic improvement was achieved.

An average of 2611 ± 1002 mL of fluid was removed per treatment.

Discussion

To our knowledge, this is the first clinical report of rapid removal of extracellular and intravascular fluid volume excess via ultrafiltration without use of a central venous catheter. Ultrafiltration resulted in decreases in body weight without changes in vital signs or laboratory parameters.

In this trial, the primary endpoint of greater than 1 L of ultrafiltrate removal in 8 hours or less was achieved in 23 of 25 treatments, or 92%. In both cases in which this was not achieved, venous

Conclusions

In the future, studies may be of interest comparing peripheral ultrafiltration to pharmacologic therapy alone with endpoints of fluid removal, hospital duration, or cost. In this series, 3 patients were treated as outpatients, suggesting that early application could obviate the need for hospitalization in selected patients with volume overload states.

References (16)

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*

Reprint requests: Brian E. Jaski, MD, San Diego Cardiac Center, 3131 Berger Avenue, San Diego, CA 92123.

**

1071-9164/03/0903-0011$30.00/0

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