Peripherally inserted veno-venous ultratiltration for rapid treatment of volume overloaded patients

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 less than or equal to 40 mL/min, ultrafiltrate less than or equal to 500 mL/h) were placed by nonphysician personnel in upper extremity veins. Twenty-five treatments of up to 8 hours were per-formed in 21 patients. Results: The primary endpoint of greater than I 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.