One of the exciting things about working in the medical profession is that you get to experience newer technology as it develops. I thought I would take the time to write about an interesting new medical technology and procedure that I have recently learned about: Aquapheresis-a treatment for congestive heart failure and other problems. In fact, my medical floor is changing the way it treats patients, and aquapheresis is becoming a standard treatment for CHF patients.
What is Aquapheresis? Aquapheresis Medical Definition
Aquapheresis is a medical technology designed to remove excess salt and water from the body as safely, predictably, and effectively as possible from patients suffering from a condition called fluid overload. It removes the excess salt and water and helps to restore a patient’s fluid balance (or euvolemia). Aquapheresis is most commonly used to treat a condition called fluid overload or hypervolemia.
Why is Aquapheresis Necessary?
Fluid overload can be caused by many reasons, including heart failure, liver cirrhosis, hypertension and certain kidney diseases. Fluid overload can also be experienced after certain surgical operations. Fluid overload is most commonly seen in patients experiencing congestive heart failure.
When this fluid overload occurs, swelling is often present. Swelling can become severe in some cases, leaving the patient with discomfort, pain, or other health risks. Sometimes, this fluid can affect the lungs and cause breathing difficulties. The swelling can present in any location, but is most often found in the extremeties (arms/legs), and abdomen region.
Aquapheresis is an alternative treatment for patients who don’t see results from other treatments from diuretics such as lasix.
How Does Aquapheresis Work?
Blood containing excess salt and water is withdrawn from a patient using peripheral or central venous catheters and passed through a special filter. Using a form of ultrafiltration, the filter separates the excess salt and water from the blood and the blood is returned to the patient while the fluid is collected in a bag for later disposal.
Anti-coagulation therapy is often used with aquapheresis to prevent blood from clotting the ultrafiltration filter. Patients must discontinue any anticoagulant medications before starting aquapheresis so they can be placed on intravenous Heparin therapy. Once the Heparin therapy is initiated, the patient’s PTT (partial thromboplastin time) levels will be monitored closely per hospital protocol to prevent excessive anti-coagulation. If a patient is allergic to Heparin or has a condition known as Heparin-induced Thrombocytopenia (HIT), an alternative intravenous anti-coagulate may be used, such as Argatroban.
The blood is outside the body for less than a minute and the total amount of blood is 33 milliliters (2.5 tablespoons). It is thus an extracorporeal therapy.
The fluid removed is isotonic to blood and therefore electrolyte balance is maintained throughout therapy and up to 3.2 grams of sodium per liter can be removed.
Aquapheresis therapy is delivered by three basic components: a console (the machine with two pumps), the blood filter circuit, and the venous catheter(s).
18 gauge peripheral I.V. can be used to administer treatment, however, it is recommended by the manufacturer that a central line be used (such as a power picc) or a CHF Solutions Picc Line (a special line made by the company who makes the Aquadex FlexFlow machine used for aquapheresis)
My Personal Experience with Aquapheresis
I think this is an interesting treatment. I seen 11 liters of fluid removed from a patient after only 2 days of treatment. The patient looked remarkably better after the treatment, which is amazing considering diuretics don’t seem to be nearly as effective in reducing fluid overload.
I think this is going to become a more standardized treatment over time, and will gain more exposure in hospitals. It may one day be as common as a kidney failure patient getting a dialysis. I can see patients one day checking in every month or so to get their excess fluid removed.
Sarah Registered Nurse RN