Citrate anticoagulation has been used as an alternative to heparin for hemodialysis in high-risk patients; however, its use in hemofiltration has not been well studied. We examined citrate in 6 patients placed on slow hemofiltration for up to 6 h duration. During the experiments, the systemic citrate level increased from a baseline average of 0.15 to 0.55 mmol/l, and then decreased to 0.27 mmol/l. The citrate was freely filtered. The systemic total and ionized calcium decreased very slightly and no untoward effects were noted. Anticoagulation was successful. This preliminary study suggests that citrate anticoagulation can be used in slow hemofiltration.
Fifteen peritoneal-dialysis spike connectors were contaminated deliberately, either by handling (n = 12) or by a saline suspension of micro organisms (n = 3). The spikes were then subjected to ultraviolet light in a Germicidal System according to the manufacturer's instructions. Subsequent culture revealed that the device had sterilized the spikes contaminated by aqueous suspensions. In 25% of the tests, the spikes which were handled and contaminated by skin nor a had positive cultures. These results cast doubt on the efficacy of such a device. Peritonitis, a major complication of peritoneal dialysis, is especially troublesome during continuous ambulatory peritoneal dialysis (CAPD). Here, the most common pathogens are skin flora (1), which is thought to be due to the frequent connections and disconnections needed in this method of treatment (1, 2). To reduce the incidence of contamination during the connecting procedure, Travenol Corporation has introduced a Gennicidal System (Model 5C-34–30). This system uses ultraviolet (UV) light to sterilize the connection between the patient line and the dialysate bag. The present study was done to test the efficacy of this system by violating the recommended aseptic technique in a manner which would simulate patient non-compliance. We believe that testing with aqueous suspensions of bacteria is not an adequate challenge to the system because skin contact leaves oils and debris which may shield bacteria from the UV light (3,4).
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