Large Volume Ultrafiltration in Acute Decompensated Heart Failure Using Standard Peripheral Intravenous Catheters

Pharmacotherapy of acute and chronic heart failure: Part 1

“…Although there was no increase in serum creatinine of greater than 0.3 mg/dL at 24 or 48 hours, serum creatinine was higher throughout the hospitalization in the UF arm and an "area-under-the-curve" analysis of creatinine might reveal differences. Previous trials have shown similar increases in serum creatinine with UF, and it is well known that even modest changes in serum creatinine have been associated with increased mortality [6,7]. The UNLOAD was an important fi rst trial evaluating UF in patients with acute HF.…”

Ultrafiltration for Congestive Heart Failure

“…Congest Heart Fail. with UF, 23,27,29,39,40 though one study demonstrated a slight decrease, 41 while other electrolytes remain stable. 28,38,42,43 UF also has a favorable effect on pulmonary function, ventilation efficiency, water content in the lungs, 33,36,37,44 plasma neurohormones including norepinephrine, renin and aldosterone, 38,42,45 and diuretic responsiveness 29,39,42,45,46 ( Table III).…”

“…However, only patients in the UF arm of UNLOAD experienced improved clinical outcomes suggesting that both the amount of fluid removed and the sodium content of the fluid removed are important in the management of acute 62 Newer technology has allowed for the use of peripheral venovenous UF that does not require monitoring in the intensive care unit setting and can be performed by standard nurses after appropriate training. 41,43 This does reduce the risk and cost associated with UF. However, vascular access is still necessary as well as systemic anticoagulation with heparin during the course of the UF treatments.…”

A Practical Guide for Ultrafiltration in Acute Decompensated Heart Failure

“…As a result of recent research with the use of peripheral IV access for ultrafiltration, newer generations of the Aquadex FlexFlow system have instrumentation that provides information with regard to the pressures being generated in the withdrawal line, the filter itself, and the reinfusion line. 22 This is a tremendous improvement because it provides critical information related to pump dysfunction and allows for rapid troubleshooting of access-related issues. In general, the reinfusion line should be connected to the largest and shortest access, as this is where hemoconcentration is maximal and thus the resistance to flow needs to be minimized.…”

“…As a result of the relatively minimal flow required by the Aquadex system (usually 40 mL/min but can be as little as 10 mL/min), peripheral IV access and smaller bore central access have been shown to be effective for ultrafiltration as compared with conventional ultrafiltration, which requires large bore central venous access. 22 A standard ultrafiltration protocol (Table) was developed at the University of Minnesota based on experience using the Aquadex FlexFlow system in patients hospitalized with acutely decompensated heart failure. All patients with acceptable peripheral venous integrity as determined by adequate visible veins and the registered nurses' ability to place a standard peripheral IV undergo the attempt for placement of 3 standard 18-gauge peripheral IV catheters in the upper extremities (2 for clinical use and 1 for backup in case of IV infiltration).…”