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Howard

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									Impact of the       CRIT-LINETM:
A Comparative Observational Study


      Andrew D. Howard, MD, FACP
  Metropolitan Nephrology Associates, PC

         Barbara Palmer, RN, CNN
   Director of Nursing, Mt. Vernon QCDC
                Objective

• Examine the effect of the CRIT-LINETM
  device in OP dialysis on:

  • Fluid Overload

  • Complications with vascular access

  • Morbidity associated with excessive UF
               Study Design
                      Setting

• Two 12 station OP dialysis facilities in the
  Metropolitan Washington, DC area
   • CRIT-LINETM Unit: Mt. Vernon QCDC
    CRIT-LINETM use beginning May 1997
   • Control Unit: La Plata BMA

• Prospective data: May - September 1997

• Retrospective data: 1995 & 1996
           Study Design
Setting - Average Number of Patients Annually


             1995       1996       1997


Mt. Vernon 66           65         56


La Plata     60         59         57
                  Study Design
       Methods: CRIT-LINETM Protocol

• UF goal set for target weight

• Nurse can add or subtract 200 ml from UF goal every 30 minutes if
  % change BV <3%/hr or >5%/hr

• From CRIT-LINETM display nurse records q 30 min:

   •   % change BV, Hct, O2 sat, Intervention

• Physician to review nursing flow sheets & CRIT-LINETM graphs on
  weekly rounds

• Recirculation test using CRIT-LINETM every month
                   Study Design
             Methods: Data Collected

• Retrospective data
  •   # Dialyses missed: Hospitalization for Fluid Overload
  •   # Dialyses missed: Hospitalization for Access Complications
  •   # Dialyses missed: Any Hospitalization
  •   # Dialyses missed: Total
  •   Use of Hypertonic Saline

• Prospective Data
  •   Nausea/Vomiting
  •   Hypotension (BP systolic<100 mmHg)
  •   Cramping
  •   Administration of extra normal saline
  •   Dizziness
      Number of OP Dialyses Missed
                                    Due to Hospitalization
                                for Dialysis Access Problems


                           90                                  1995
Annually per 50 Patients




                           80
  # Dialyses Missed




                                                               1996
                           70
                           60                                  1997
                           50
                           40
                           30                        CRIT
                                                     -LINETM
                           20
                           10
                            0
                                  La Plata        Mt.
                                                Vernon
         Number of OP Dialyses Missed
                                  Due to Hospitalization
                                   for Fluid Overload


                           90                                 1995
Annually per 50 Patients




                           80
  # Dialyses Missed




                                                              1996
                           70
                           60                                 1997
                           50
                           40
                           30
                           20
                                                    CRIT
                           10                       -LINETM
                            0
                                La Plata         Mt.
                                               Vernon
                             Total OP Dialyses Missed


                           700                             1995
Annually per 50 Patients




                           600
  # Dialyses Missed




                                                           1996
                           500                             1997
                           400
                           300                   CRIT
                                                 -LINETM
                           200
                           100
                            0
                                 La Plata     Mt.
                                            Vernon
             Hypertonic Saline Administered


                           12000
Annually Per 50 Patients




                           10000                            1995-96
  Hypertonic Saline




                                                            1997
                           8000

                           6000

                           4000

                           2000                   CRIT
                                                  -LINETM
                              0
                                   La Plata     Mt.
                                              Vernon
               Change in Key Variables
           1997(CRIT-LINETM Period) vs. 1995-96
           50                     La Plata             Mt. Vernon(CRIT-LINE)

           30

           10
% Change




           -10
                                                                                    -14%
           -30

           -50                                      -38%
                    -52%                                           -47%
           -70
                                    -74%
           -90               Dialyses Missed                  Dialyses Missed
             Dialyses Missed Fluid Overload Dialyses Missed         Total     Hypertonic Saline
             Access Problems                Any Hospitalization                 Administered
                                                   Morbidity
           1997 - Control Unit vs. CRIT-LINETM Unit
                                    La Plata      Mt. Vernon (CRIT-LINE)

                           2000                                              P<0.0005
Annually per 50 Patients
  Number of Events




                           1500
                                                P<0.0005

                           1000                                 P=0.006


                           500
                                   P=0.30
                                                                                                 P=0.51

                             0
                              Nausea/Vomiting                   Cramping                       Dizziness
                                                  Drop in                   Normal Saline
                                               Blood Pressure              Given for Support
             Conclusions

• For patients in CRIT-LINETM Unit:
  • Lower morbidity associated with
   aggressive UF
  • Lower number of hospitalizations for
   access problems and fluid overload
  • Fewer dialyses missed

								
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