Abstract: FR-PO470
A Single-Center Experience Piloting the Tablo Hemodialysis System for Intermittent Hemodialysis (IHD) in an Acute Hospital Setting: A Quality Improvement Project
Session Information
- Hemodialysis and Frequent Dialysis - IV
November 08, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 701 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Sylvia-Reardon, Mary H., Massachusetts General Hospital, Boston, Massachusetts, United States
- Culbert-Costley, Roberta L., Massachusetts General Hospital, Boston, Massachusetts, United States
- Robbins, Alexis Ann, MGH, Boston, Massachusetts, United States
- Allegretti, Andrew S., Massachusetts General Hospital, Boston, Massachusetts, United States
- Tolkoff-Rubin, Nina E., Massachusetts General Hospital, Boston, Massachusetts, United States
Background
The TABLO hemodialysis system integrates on-demand dialysate production, reverse osmosis (RO) water purification and computerized data collection into a single mobile unit. The system provides a maximum dialysate flow rate (Qd) of 300ml/minute. Kinetic modeling and outpatient clinical experience show that adequacy targets (urea reduction ratios [URR] greater than 65%) can be achieved. This Quality Improvement project was undertaken to evaluate the performance of TABLO in patients undergoing intermittent hemodialysis (IHD) in an acute care setting.
Methods
Between January and February 2019, 25 hospitalized patients with acute (17) or end stage renal failure (8) received hemodialysis therapy with the TABLO. Treatment parameters including URR, ultrafiltration (UF) accuracy, serum potassium and treatment complications were recorded.
Results
TABLO was used for a total of 46 hemodialysis treatments. Thirty two % of patients had weights greater than 100 kg. Vascular access was tunneled catheter (57%) AV fistula (21%) non-tunneled catheter (14%) and AV graft (8%). Ninety two percent used an Opti 180 and 8% used an Opti 200 dialyzer. The average URR was 68% (SD11) with an average dialysis time of 3.7 hours. Pre-dialysis potassium averaged 4.5 mmol/L. Potassium obtained the day after dialysis averaged 4.1 mmol/L. Blood flow rates averaged 371 (SD54) cc/minute. Average prescribed and achieved UF for patients was 1.7 L. Six treatments were terminated early due to access problems, hypotension or clotting . Seven therapies required a second setup due to clotting . These runs were subsequently completed.
Conclusion
This QI project demonstrates that the TABLO provides adequate URR with Qd 300ml/min and accurately meets UF targets in the majority of patients requiring IHD in the acute care setting. Water pressure problems frequently encountered with Fresenius 2008T machines were not encountered with TABLO . The TABLO's small footprint ( size of a dormitory refrigerator) facilitates travel to multiple ICUs. The TABLO was welcomed within the space constraints of ICU rooms. Low dose heparin and/ or periodic saline flushes may be required to prevent clotting. Further studies will be required to assess potassium removal in highly catabolic patients.
Funding
- Clinical Revenue Support