Circuit Patency, Access & Anticoagulation for Renal Replacement Therapy Archives

Which patients can have RRT without pharmacological anticoagulation? How can filter life be extended if no anticoagulation is used?

Pharmacological anticoagulation is not required in patients: With impaired coagulation (e.g. liver failure or dilution coagulopathy) On systemic anticoagulation Impaired anticoagulation is suggested by any one of the following: INR >2-2.5 APTT > 60 seconds...

How do you monitor anticoagulation during RRT?

Filter & Circuit Patency Filter Efficacy Anticoagulant Effect Complications Techniques Visual ChecksAccess pressuresFiltration fraction FUN/BUN ratio UFH: ACT post-filter / aPTTLMWH: anti-XaCitrate: systemic and post-filter ionised calciumProstacyclin:...

Which mode of anticoagulation should be used during RRT? Which mode of anticoagulation should be used in Heparin Induced Thrombocytopenia (HIT)?

If No Increased Risk of Bleeding Regional citrate rather than heparin as first line unless contraindicatedIf citrate contraindicated or as a second line alternative either unfractionated or low molecular weight heparin If Increased Risk of Bleeding Regional citrate...

What are the types of anticoagulation that can be used for RRT? What are the advantages and disadvantages of each mode?

Mechanical Optimising CVPPre-dilution replacement fluidHigh flowratesReducing air-blood contact in the bubble trap Regional HeparinCitrate Systemic HeparinLMWHProstacyclinThrombin Inhibitors:ArgatrobanLepirudinFondaparinuxHeparinoidsWarfarin No / Mechanical...

Which factors can increase the risk of circuits clotting during RRT?

Poor vascular access Kinking of lines and tubes Reduced blood flows Convective rather than diffusive therapies Coagulopathic patient Poor anticoagulant choice/dose Bio-incompatible...

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