Published in:
01-07-2003 | Technical Note
A novel citrate anticoagulation regimen for continuous venovenous hemodiafiltration
Published in: Intensive Care Medicine | Issue 7/2003
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Objective
Validation of a novel citrate anticoagulation regimen for continuous venovenous hemodiafiltration (CVVHDF).
Design and setting
Prospective cohort trial in medicosurgical intensive care units of two university-affiliated teaching institutions.
Patients
Participants were patients at high risk for bleeding, with renal failure requiring CVVHDF without heparin. Fourteen patients completed the study.
Intervention
A convection-based citrate anticoagulation CVVHDF regimen using an isotonic replacement fluid containing citrate administered in predilution. A neutralizing solution of calcium chloride and magnesium sulfate was infused at the end of the circuit. Blood flow rate was set and kept at 125 ml/min, and the flow rate of the replacement fluid was initiated at 1250 ml/h and adjusted thereafter according to the monitoring of blood activated coagulation time (ACT), with a target between 180 to 220 s.
Measurements and results
The average filter time-life was 44 h. Thrombosis of the proximal portion of the circuit (which was not anticoagulated) was the main reason for technique failure. A mean urea clearance of 21 ml/min was obtained. Electrolytes and acid-base balance were both well maintained. Six percent (16/287) of Cai readings less than 0.3 mmol/l were associated with very high ACT levels (>300 s).
Conclusions
This regimen is shown to be safe, efficacious, and convenient. Citrate anticoagulation should be monitored using postfilter ACT and/or ionized calcium with respective targets of 200–250 s or 0.3–0.4 mmol/l.