Non-anticoagulation pediatric continuous renal replacement therapy methods to increase circuit life
Title
Non-anticoagulation pediatric continuous renal replacement therapy methods to increase circuit life
Creator
Rupesh Raina
Sidharth Sethi
Amrit Khooblall
Vijay Kher
Shweta Deshpande
Keval Yerigeri
Aadi Pandya
Nikhil Nair
Nithin Datla
Mignon McCulloch
Timothy Bunchman
Andrew Davenport
Date
2022
Description
Introduction: Acute kidney injury (AKI) is a clinical condition characterized by an abrupt increase in serum creatinine levels due to functional changes in the kidneys from a newfound insult or injury. For supportive treatment, continuous renal replacement therapy (CRRT) is one of the most widely used modalities due to its precise control of fluid balance over extended periods of time. However, its complications include circuit clotting, the most frequent cause for CRRT interruption. Vascular access and circuit management were found to be major determinants of performance efficiency. Anticoagulation required to prevent clotting has the downside of increasing the risk of bleeding, especially in the setting of overdosage. Hence, a delicate balance needs to be maintained consistently.
Methods: This study explores the adequacy of non-anticoagulation measures in the prevention of circuit clotting. A comprehensive literature search was conducted using PubMed/Medline and Embase databases to include all relevant studies.
Findings: The most-effective CRRT catheter would be made of nonthrombogenic material, noncuffed and nontunneled with separate lumens for arterial and venous blood. Further, studies show that blood flow during the process is optimized at 200 ml/min, which can be lowered in the pediatric population due to more narrow catheters. Platelet count and hematocrit need to be closely monitored as levels above 450,000 × 106 /L and 0.40, respectively, increase risk of clotting. Predilution is a non-anticoagulation technique to reduce the risk of clotting by returning replacement solution to the blood before it reaches the filter. Also, biocompatible membranes such as polyacrylonitrile or polysulfone activate the coagulation cascade significantly less than the conventional cellulose-based membranes, thereby reducing clotting chances.
Discussions: With the advent of such techniques and maneuvers, anticoagulation can be efficiently maintained in patients undergoing CRRT without increasing the risk of bleeding.
Methods: This study explores the adequacy of non-anticoagulation measures in the prevention of circuit clotting. A comprehensive literature search was conducted using PubMed/Medline and Embase databases to include all relevant studies.
Findings: The most-effective CRRT catheter would be made of nonthrombogenic material, noncuffed and nontunneled with separate lumens for arterial and venous blood. Further, studies show that blood flow during the process is optimized at 200 ml/min, which can be lowered in the pediatric population due to more narrow catheters. Platelet count and hematocrit need to be closely monitored as levels above 450,000 × 106 /L and 0.40, respectively, increase risk of clotting. Predilution is a non-anticoagulation technique to reduce the risk of clotting by returning replacement solution to the blood before it reaches the filter. Also, biocompatible membranes such as polyacrylonitrile or polysulfone activate the coagulation cascade significantly less than the conventional cellulose-based membranes, thereby reducing clotting chances.
Discussions: With the advent of such techniques and maneuvers, anticoagulation can be efficiently maintained in patients undergoing CRRT without increasing the risk of bleeding.
Source
Hemodial Int
. 2022 Apr;26(2):147-159. doi: 10.1111/hdi.13003. Epub 2022 Jan 5.
. 2022 Apr;26(2):147-159. doi: 10.1111/hdi.13003. Epub 2022 Jan 5.
Language
English
URL
https://doi.org/10.1111/hdi.13003
Citation
Rupesh Raina et al., “Non-anticoagulation pediatric continuous renal replacement therapy methods to increase circuit life,” NEOMED Bibliography Database, accessed May 1, 2024, https://neomed.omeka.net/items/show/12052.