In vitro use of standard fluid infusion central venous catheter for slow continuous ultrafiltration feasibility assessment

Abstract

Background: Slow continuous ultrafiltration (SCUF) by central venous catheter (CVC) for hemodialysis is a simple extracorporeal ultrafiltration that can reduce and control fluid overload in patients with chronic or acute chronic heart failure unresponsive to medical therapy. In order to avoid complications and risks related to the catheterization with a standard CVC for hemodialysis to provide the SCUF, considering that hospitalized patients affected by congestive heart failure commonly undergo CVC placement for medications delivering, we tested an in vitro model to use a standard CVC for infusion to perform SCUF. Methods:We performed an in vitro SCUF experimental model through two different lumens of a triple (8Fr × 20 cm Tri-lumen catheter Kit-Envans Extra) and a quad-lumen CVC (8.5Fr × 20 cm Quad-lumen catheter kit-Benefis Medical Devices) commonly used in our Intensive Care Unit for fluids and medications infusions. We used Prismaflex with the HF-20 set (Baxter, IL, USA) to perform the SCUF treatment.Results: Our in vitro data confirm the technical feasibility of the use of standard CVC for fluid infusion to perform a SCUF treatment with a theoretical weight loss of up to 200 ml/h by a blood flow ranging from 30 to 45 ml/min. Conclusions:The use of standard infusion CVC could be utilized in the intensive care unit to perform SCUF not exposing patients to the risks and complications related to the placement and permanence of CVC for hemodialysis.

Slow Continuous Ultrafiltration in Regional Citrate Anticoagulation Performed with a Standard Fluid Infusion Central Venous Catheter in Intensive Care Unit for Fluid Overload in Acute on Chronic Heart Failure: A Case Report

“…According to previous in-vitro study by Nalesso et al [12], we provided the SCUF in Regional Citrate Anti-Coagulation, using the quad-lumen CVC placed in the right jugular vein (8.5 Fr × 20 cm Quad-lumen catheter kit-Benefis Medical Devices). As previously demonstrated in vitro by Nalesso et al [12], this type of CVC is suitable to achieve an adequate blood flow to obtain at least an ultrafiltration of 200 mL/h.…”

“…According to previous in-vitro study by Nalesso et al [12], we provided the SCUF in Regional Citrate Anti-Coagulation, using the quad-lumen CVC placed in the right jugular vein (8.5 Fr × 20 cm Quad-lumen catheter kit-Benefis Medical Devices). As previously demonstrated in vitro by Nalesso et al [12], this type of CVC is suitable to achieve an adequate blood flow to obtain at least an ultrafiltration of 200 mL/h. According to current legislation, the use of infusion CVC, being classified as vascular access device, does not configure the off-label use of this infusion catheter to perform the SCUF as the manufacturer's user manual.…”

“…Since SCUF treatments could be performed with a very low blood flow rate [11], using two different lumens of these CVC would be possible to achieve an adequate blood flow rate for the SCUF while the other lumen(s) can be used for the fluid and medication infusion. As previously reported by Nalesso et Al., it was possible to achieve an adequate blood flow and ultrafiltration through the use of standard infusion CVCs in vitro to obtain the fluid removal for the treatment of patients with fluid overload [12]. In this technique, the regional anticoagulation with sodium citrate was used to minimize the filter and circuit clotting due to the low blood flows obtained through the standard CVCs without exposing the patient to a further clinical risk related to the systemic anticoagulation with heparin [12].…”

“…As previously reported by Nalesso et Al., it was possible to achieve an adequate blood flow and ultrafiltration through the use of standard infusion CVCs in vitro to obtain the fluid removal for the treatment of patients with fluid overload [12]. In this technique, the regional anticoagulation with sodium citrate was used to minimize the filter and circuit clotting due to the low blood flows obtained through the standard CVCs without exposing the patient to a further clinical risk related to the systemic anticoagulation with heparin [12].…”