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
    • Thrombocytopenia e.g. platelet count < 60 x 103/mm3
ICS Guidelines

G

From KDIGO Guidance:

  • Good vascular access allowing high blood flows to be reliably achieved
  • Reducing blood viscosity through the filter
  • Predilution fluids
  • Treatments that involve diffusion as opposed to ultrafiltration
  • Reducing blood-air contact in the bubble trap
  • Ensuring prompt response to the filter alarms resulting in rapid correction of any suboptimal filter conditions which may have arisen

 

Other

  • Prime the circuit with saline or heparin
  • Give intermittent 0.9% saline flushes (50-200ml every 30-60mins)