I have a pt who has been on dialysis for ten yrs mid seventies in age. Two heart attacks in the past, with what the doctor calls a poor ejection factor. What is meant by a poor ejection factor and how would that influence, if anyway, my ability to remove fluid using a blood volume monitoring device?

Dear RN,CNN:
I think that your physician was referring to a poor ejection fraction. An ejection fraction is a measure of ventricular contractility. A low ejection fraction is indicative of ventricular dysfunction. This is relatively common among dialysis patients and may be the consequence of ischemic heart disease secondary to coronary artery disease, diabetes,valvular heart disase and others.Many times these patients have refractory congestive heart failure. Management of these patients is not always easy because in order to imptove left ventricular filling and relaxation, it is necessary to reduce extracellular fluid volume. Since low ejection fraction may be associated with dialysis induced hypotension,the effectiveness of fluid removal may be comprimised during dialysis. Volume monitoring can certainly help to remove the maximum amount of fluid while maintaining an adequate blood pressure. Devices sch as the Crit-Line allow the clinician to be pro active since you have a window into the vascular space.