Methods and challenges for the practical application of Crit-Line™ monitor utilization in patients on hemodialysis

The Crit-Line™ monitor measures relative changes in intravascular blood volume during hemodialysis. The device is also used to monitor hematocrit and oxygen saturation. Using this device to decrease fluid volume has yielded inconsistent results on outcome measures such as hospitalization rates, erythropoietin utilization, and blood pressure reduction. Through a year-long deployment of the Crit-Line™ monitor, the Renal Research Institute (RRI) has shown that outcomes can be improved even in a busy dialysis clinic with attention to the details of how the device is utilized. In this paper, we are proposing areas of focus and methods that if properly implemented should yield improved clinical outcomes. Strong physician approval and enthusiasm coupled with clinical staff support have been shown to be vital to the success of this device in improving clinical outcomes. Even in this setting, inadequately and improperly trained staff have been identified as almost insurmountable impediments to adequate Crit-Line™ use. Our studies have shown that in facilities where staff turnover is high, procedures must be implemented to engage and train new staff immediately upon their arrival on the dialysis floor. Other issues that may lead to improper use of the Crit-Line™ monitor include incorrect target weight assessments, failure of staff to properly monitor patients during the treatment, and the over dependency of saline administration for cramps.