CLINICAL EVALUATION

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CLINICAL EVALUATION
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Evaluation Objectives

• 24 patients monitored for 4 patient treatments
• 8 additional chronic and acute patients monitored
  for fluid status at the request of the physician
  and nurses
• 1 patient spot checked pre and post blood
  transfusion for HCT level
• Pre and post weights monitored and UF goal
  adjusted using blood volume monitoring
• O2 saturation monitored and O2 administered to
  provide patient comfort
• Data gathered to provide asymptomatic treatments

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Overall Weight Changes During The Study
20 Achieved lower weights than pre study
3 No weight change
1 Gained weight
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Significant Findings

• A profiles (flat or positive deflection of
  graph)
• 50 (12 of 24) of the patients with beginning A
  profiles were changed to B profiles by
  decreasing body weight. 13 (3 of 24) remained
  A profiles at the end of the study suggesting
  that more fluid remains.
• O2 saturation
• 38 (9 of 24) of the patients were identified as
  having a significant drop in their O2 saturation
  during treatment. Oxygen administration allowed
  for greater fluid removal, patient comfort and
  hypotension stabilization.

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Changes in Profiles
B
A
C
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(No Transcript)
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Case Study Patient S

• Problem Patient complains of shortness of
  breath, discomfort in supine position. DW 65.5,
  last post weight prior to study 65.2 kg.
• Results Patient dry weight reduced 3.2 kg in 3
  treatments without morbidity. States much more
  comfortable at new weight of 62.3 kg.

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Patient S Hematocrit Change

• May 1 HCT (start) 29.1
  HCT (max) 32.3
• May 3
• HCT (start) 30.6 HCT (max) 33.9
• May 5
• HCT (start) 30.2 HCT (max) 32.4

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Patient S ?BV

• May 1
• Profile A-Goal increased from 2.6 to 3.8 kg-No
  morbid events.

• May 3
• Profile A-Goal increased from 2.2 to 3.6kg-No
  morbid events.

• May 5
• Profile A-Goal increased from 2.7 to 3.0-No
  morbid events-DW check reveals that DW could
  possibly be reduced further. Patient reported SOB
  greatly improved.

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Case Study Patient L

• Problem Fluid Overload, SOB (Uses O2 at home),
  2 pretibial edema, unable to walk up stairs
  without assistance.
• Results Patients original dry weight was 99.3
  kg. Last weight prior to study 100.3. The
  Crit-Line was utilized to achieve a new dry
  weight of 96.8 kg, a decrease of 2.5 kg in just
  two treatments.

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Patient L Hematocrit Change

• May 2 HCT (start) 35.5
  HCT (max) 38.1
• May 4
• HCT (start) 33.5 HCT (max) 36.8
• May 7
• HCT (start) 33.7 HCT (max) 40.2

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Patient L ?BV

• May 2
• Increased goal by 1 kg, without morbid events.

• May 4
• Increased goal by another 1.3 kg, again without
  morbid events.

• May 7
• Goal 4.5 achieved without intervention except
  body position. Patient reports that she is able
  to walk up steps without help, SOB much better.

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Case Study Patient C

• Problem Fluid overload, 2 pretibial edema,
  mild SOB.
• Results Original dry weight of 101.5 kg. After
  three treatments utilizing the Crit-Line, a new
  dry weight of 99.8 kg was established. Patient
  could possibly still be challenged further.
  Patient felt better during dialysis with
  administration of oxygen.

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Patient C Oxygen Saturation

• May 1 O2 (start) 91
• (min) 88, (end) 92
• May 3
• O2 (start) 80
• (min) 73, (end) 95
• May 5
• O2 (start) 88
• (min) 86, (end) 92

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Patient C ?BV

• May 1
• No goal increase, B slope.

• May 3
• Oxygen applied, increased goal by 1.3 kg without
  morbidity.

• May 5
• O2 applied, goal increased .6 kg. New dry weight
  of 99.8kg achieved, but patient still has
  relatively flat line would consider further
  challenging dry weight.

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Summary

• The Crit-Line monitoring system provides an
  effective tool to
• enable the clinician to be proactive and prevent
  morbid events
• establish new dry weights
• evaluate access problems using access blood flow
  along with access recirculation.
• A real time HCT value can be used for Epogen
  management and Epogen reimbursement.
• A real time Oxygen Saturation during treatment
  identifies deficits and sleep apnea.