Can a center use the HCT from a blood volume monitoring device to dose a pts EPO? If the center can, then could the center use the HCT from the device to Bill HCFA? If so, which HCT do you use the beginning, middle, end or when? Does the center need documentation for the HCT, print out or written, what is acceptable, if any of this is?

A clinic can absolutely use the hematocrit taken from the Cri-Line to dose EPO. You can also use those hematocrits to bill HCFA for EPO. I believe the crit that is used is the last one taken before the last dose of EPO is given for a particular month. You can print out the hematocrits taken from the Crit-Line to use as documentation. You may or may not know that the Crit-Line is a CLIA exempt device.In actuality you would not have a need to send hematocrits to a Lab. if you use the Crit-Line to monitor hematocrits.

quote:

Originally posted by RNCNN:
Can a center use the HCT from a blood volume monitoring device to dose a pts EPO? If the center can, then could the center use the HCT from the device to Bill HCFA? If so, which HCT do you use the beginning, middle, end or when? Does the center need documentation for the HCT, print out or written, what is acceptable, if any of this is?

Were you asking what Hct reading during the monitored treatment should be used to determine EPO dosing? A lot of clinicians have asked this same question when they are monitoring patients' Hct using critline since it gives them a real-time Hct from start to finish. If your unit collects H&H at the beginning of treatment, then you are using the beginning Hct, or starting Hct reading from the critline. Clinicians have expressed concern that beginning Hct's are usually diluted esp. in patients who are overloaded. What do you think?

I have noticed that if you give the pt the saline prime, 250cc in our unit, that it drops the pts HCT by one or two pts. This would be the closest value to our pre lab draws, so I would be inclined to use this value the starting HCT. What is everyone elses opinion?

See Dialysis and Transplantation, April 2000, p.250 - "Pre-Dialysis Hypoalbuminemia: Is It Nutritional, Medical, or Diutional?"

This article discusses your Hct question from an albumin standpoint.

Their conclusion: "It may be inappropriate to use pre-dialysis .... as an indicator... since levels drawn at that time are significantly altered by the effect of excess fluid."

If we don't use the pre lab work or the starting HCT what should a clinic use? Further into the run the HCT should increase therefore we would give less EPO? My docs want their pts to receive the max dose but maybe we need to further investigate

Is the idea to give the patient more EPO or have a stable hematocrit that is within the target range? As long as you are consistent with the timing of the hematocrit, I don't think it really matters. We know that the pre-dialysis hematocrit is diluted, but if that is the one we use consistently, it should not adversly effect the patient.

I am a patient, and would like to see my clinic get Crit-Lines to monitor Hct.
Would it be financially advantageous for them to do so? How can I convince them?
At present, they draw blood every week or two, on Mondays, send it from CA to the company lab in NJ, and get the result on Friday. It's no way to run a railroad. I've had three episodes of Hct going too high or too low, with rather severe consequences.
How much do the units cost, anyway?