Recently, we have started to place more Aquapheresis catheters for cardiac patients. They are only 15cm long and we seem to be having a lot of problems getting them to continue to withdraw blood over 24 to 48 hrs for this therapy. Does anyone else have any experience with this system? If so, do you have success with these midline catheters?
An aquapheresis or ultrafiltration catheter is ***not*** the same as a midline catheter. A midline catheter will have the tip residing in the basilic, cephalic or brachial vein at or below the level of the axilla and distal to the shoulder. An ultrafiltration catheter will usually have the tip residing within the axillary vein which extends from about the lateral edge of the chest wall to the lateral edge of the clavicle. So a midline catheter would not be inserted as far as an ultrafiltration catheter. This has also been called the same tip location as what came to be known as the midclavicular tip location many years ago. This tip location was reported to have a high rate of thrombosis when used for infusion. I am not familiar with reported outcomes of this procedure but you could be dealing with some of the same issues of vein thrombosis as what was seen with the old midclavicular tip location. My main point is that they should not be categorized as a midline catheter for routine infusion. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Lynn, I misspoke when I said midline catheter. I guess I just think of it that way because of the length. Also, the rep for the aquapheresis pump and catheter said although most hospitals place the line to have tip reside in the axillary vein, it can be placed to reside below the axilla as a midline location. Unfortunately, this causes problems with withdrawal (as a midline would). Since the line is not to be used for anything but the ultrafiltration process, we wondered if it would be ok to have tip located in axillary vein. Thoughts?
Mersadies Wright, RN, BSN, VA-BC
I have always been concerned about the tip location in the axillary vein, but the explanation has always been that this catheter is used for the ultrafiltation procedure only and not for infusion. I do wonder though how accurate that really is. I think it is far too easy to just start using this catheter for infusion of all types of fluids/meds if the patient required it. I have not seen any published studies on catheter outcomes for this procedure. Maybe that is what we really need. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861