Blood flow reductions during continuous renal replacement therapy and circuit life

Baldwin, Ian; Bellomo, Rinaldo; Koch, Bill

doi:10.1007/s00134-004-2440-0

Cited by 76 publications

(49 citation statements)

References 16 publications

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“…The concept of MCF has not been previously considered and, therefore, there are no other studies to compare our findings with. However, MCF is the logical extension of previous studies demonstrating that with continuous computerized Doppler-monitoring of circuit blood flow [18] major decreases in blood flow become apparent during patient movement. Such decreases can last many minutes, can be recurrent and take place without machine alarms alerting the operator [18] .…”

Section: Comparison With Previous Studiesmentioning

confidence: 99%

“…For this reason, many studies have tested therapies to prevent clotting of the extracorporeal circuit (EC) and have compared different strategies of circuit anticoagulation or CRRT modality [11][12][13][14][15][16][17] to achieve this goal. Recurrent clinical observations and studies monitoring circuit blood flow fluctuations [18] , however, strongly suggest that factors other than progressive circuit clotting and clogging may be re-sponsible for sudden loss of circuit patency. In the case of patients with femoral vascular access, such factors may include patient agitation with hip flexion, nurse-induced positional changes, and physiotherapy moving patients from supine to right or left lying position.…”

Section: Introductionmentioning

confidence: 99%

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Premature Circuit Clotting due to Likely Mechanical Failure during Continuous Renal Replacement Therapy

et al. 2010

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Objective: Failure of extracorporeal circuit (EC) function during continuous renal replacement therapy (CRRT) appears most likely due to progressive circuit clotting or, in some cases, most likely due to mechanical problems that affect flow. We aimed to study the incidence of such likely mechanical circuit failure (MCF). Design and Setting: Retrospective observational study in an adult ICU of a tertiary hospital. Patients and Measurements: We studied 30 patients treated with CRRT via femoral vein vascular access. We obtained information on age, gender, diagnosis, mode of CRRT, circuit life, and blood chemistry. We defined MCF as ‘likely’ if there was a reduction of between 60 and 80% in circuit life compared to the previous or following circuit life and ‘very likely’ if such a reduction was between 81 and 100%. Results: We studied 166 circuits in 30 different patients. Of these 26 were electively disconnected leaving 140 circuits with unplanned cessation of function. Among these circuits, likely MCF affected 10 circuits (7.1%) and very likely MCF affected 9 circuits (6.4%) for a total of 19 (13.6%) circuits. Conclusion: Mechanical circuit failure appears to affect approximately 1 in 8 circuits. Prospective studies are needed to understand why MCF occurs.

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Section: Comparison With Previous Studiesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Premature Circuit Clotting due to Likely Mechanical Failure during Continuous Renal Replacement Therapy

et al. 2010

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“…to flow reductions due to access dysfunction [7] . Such flow reductions, in turn, are logically reflected in circuit pressure changes.…”

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confidence: 99%

Patterns and Mechanisms of Artificial Kidney Failure during Continuous Renal Replacement Therapy

et al. 2015

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Background: We aimed to describe the previously unstudied relationship between circuit pressures and circuit clotting, here labeled as ‘artificial kidney failure' (AKF), in patients receiving continuous renal replacement therapy (CRRT). Methods: We performed an observational study of CRRT-treated critically ill patients to continuously record the multiple CRRT circuit pressures. Results: Three patterns of access outflow dysfunction (AOD) were also noted: severe, moderate and mild. Compared with circuits without AOD, circuits experiencing at least one AOD episode had shorter lifespans (14.2 ± 12.7 vs. 21.3 ± 16.5 h, p = 0.057). This effect was more obvious with moderate or severe AOD (8.7 ± 4.6 vs. 20.6 ± 15.7 h, p = 0.007). If any AOD events occurred within the first 4 h, the sensitivity and specificity in predicting early-immediate AKF were 53.4 and 94.4%, respectively. Conclusions: Early and intermediate AKF during CRRT is most likely dependent on AOD, which is a frequent event with variable severity.

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“…10 The addition of pumps and accurate fluid volume control and balancing has enabled these machines to deliver a full range of CRRT modes: slow continuous ultrafiltration, continuous venovenous hemodiafiltration (CVVHDF), CVVH, and therapeutic plasma exchange (TPE). 13 Interruptions in blood flow are associated with increased circuit clotting and failure. These new systems still have the potential for significant fluid-balance errors and patient harm when alarms and machine function are not understood and when alarms are repeatedly overridden or ignored.…”

Section: Current Machines and Circuitsmentioning

confidence: 99%

Understanding the Continuous Renal Replacement Therapy Circuit for Acute Renal Failure Support: A Quality Issue in the Intensive Care Unit

Boyle

Baldwin

2010

AACN Advanced Critical Care

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Delivery of renal replacement therapy is now a core competency of intensive care nursing. The safe and effective delivery of this form of therapy is a quality issue for intensive care, requiring an understanding of the principles underlying therapy and the functioning of machines used. Continuous hemofiltration, first described in 1977, used a system where blood flowed from arterial to venous cannulas through a small-volume, low-resistance, and high-flux filter. Monitoring of these early systems was limited, and without a machine interface, less nursing expertise was required. Current continuous renal replacement therapy machines offer user-friendly interfaces, cassette-style circuits, and comprehensive circuit diagnostics and monitoring. Although these machines conceal complexity behind a user-friendly interface, it remains important that nurses have sufficient knowledge for their use and the ability to compare and contrast circuit setups and functions for optimal and efficient treatment.

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Blood flow reductions during continuous renal replacement therapy and circuit life

Cited by 76 publications

References 16 publications

Premature Circuit Clotting due to Likely Mechanical Failure during Continuous Renal Replacement Therapy

Premature Circuit Clotting due to Likely Mechanical Failure during Continuous Renal Replacement Therapy

Patterns and Mechanisms of Artificial Kidney Failure during Continuous Renal Replacement Therapy

Understanding the Continuous Renal Replacement Therapy Circuit for Acute Renal Failure Support: A Quality Issue in the Intensive Care Unit

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