Possible Strategies to Prolong Circuit Life During Hemofiltration: Three Controlled Studies

Baldwin, Ian; Tan, Han Khim; Bridge, Nicholas; Bellomo, Rinaldo

doi:10.1081/jdi-120015685

Cited by 34 publications

(24 citation statements)

References 10 publications

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“…It is cited as the reason for circuit failure in up to 23% of treatments, independent of filter clotting [4]. However, this was without a method describing how this was determined.…”

Section: Discussionmentioning

confidence: 99%

“…In this situation, it is the cause of circuit failure and treatment cessation. Chamber clotting causing treatment cessation during CRRT has been reported between 7.5% [3] and 23% of events [4]. Reducing the air blood interface by keeping the chamber full [5], extending the blood inlet line further into the chamber [6], adding fluids as post-dilution (into the chamber) [2] and infusing heparin directly into the chamber [4] have been tried to reduce clot development.…”

Section: Introductionmentioning

confidence: 99%

“…Reducing the air blood interface by keeping the chamber full [5], extending the blood inlet line further into the chamber [6], adding fluids as post-dilution (into the chamber) [2] and infusing heparin directly into the chamber [4] have been tried to reduce clot development. Unfortunately, any findings representing success are anecdotal [2,5,6] and comparative studies have found no difference [4]. …”

Section: Introductionmentioning

confidence: 99%

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Bubble Chamber Clotting during Continuous Renal Replacement Therapy: Vertical versus Horizontal Blood Flow Entry

et al. 2012

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Background: The continuous renal replacement therapy (CRRT) bubble trap chamber is a frequent site of clotting. Aims: To assess clot formation when comparing our standard ‘vertical’ blood entry chamber (BEC) with a new ‘horizontal’ BEC. Methods: Adult ICU patients requiring CRRT were treated with the vertical BEC and then a similar subsequent cohort with the horizontal BEC in continuous veno-venous haemofiltration mode. Results: 40 chambers were assessed for each design. Circuit life was 13.9 ± 9.5 h for the vertical and 17.7 ± 15.9 h for the horizontal BEC (p = 0.33). APTT, however, was higher for the horizontal BEC (55.7 ± 34.7 vs. 37.4 ± 9.0, p < 0.002) and no difference in circuit life was found after multivariable analysis. A clotting score ≥3 was observed in 85% of all chambers. There was no difference in chamber clotting score (vertical 3.6 ± 1.03 vs. horizontal 3.8 ± 1.0, p = 0.5). In addition, no difference was found when scores were divided into two groups using a ‘likelihood’ to clot analysis (p = 1.0). Conclusion: CRRT horizontal BEC were not associated with less clotting compared to our standard vertical BEC.

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“…It is cited as the reason for circuit failure in up to 23% of treatments, independent of filter clotting [4]. However, this was without a method describing how this was determined.…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Bubble Chamber Clotting during Continuous Renal Replacement Therapy: Vertical versus Horizontal Blood Flow Entry

et al. 2012

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“…Despite comparable aPTT values, the filter run times in the heparin group were shorter than those reported in previous studies, where filter lives of between 14 and 24 hours were described. [13][14][15] It could be argued that the dimension of the beneficial effect of iloprost may not be of wider clinical relevance. One explanation for the shorter run times is that the run time of each filter for each patient was included in the calculation of filter patency.…”

Section: Discussionmentioning

confidence: 99%

Iloprost for Additional Anticoagulation in Continuous Renal Replacement Therapy—A Pilot Study

et al. 2007

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Purpose. The aim of this pilot study was to compare the effect of heparin anticoagulation with and without iloprost administration during continuous renal replacement therapy (CRRT) in critically ill patients. Material and methods. In a prospective, randomized, controlled pilot study at an intensive care unit at a university hospital, 20 patients requiring CRRT were investigated. Patients were allocated into two groups: group 1, the heparin group; and group 2, the heparin plus 1 ng/kg/min iloprost. In both groups, activated partial thromboplastin time (aPTT) was adjusted to 40-50 sec. Observation time was a maximum of 7 days. Results. Median filter run time was significantly prolonged by iloprost administration to a median of 14 h (13-26 h) compared to 10 h (4-12 h) in the heparin group (p = 0.004). A decrease in platelet count was attenuated by iloprost administration (p = 0.012). There were no bleeding complications in either group. Hemofiltration efficiency did not differ significantly between the groups. Conclusion. Additional administration of iloprost prolonged the filter run time of continuous veno-venous hemofiltration (CVVH) in this setting and attenuated the fall in platelet count during CRRT.

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“…Non-anticoagulatory strategies to achieve increased circuit longevity without the bleeding risks of anticoagulation have been tested and include use of flat-plate filters, the direct administration of heparin into the air-bubble trap and the use of filters with larger surface area. None of these small studies were shown to significantly prolong circuit lifespan [5]. The problem of circuit clotting remains an important clinical and nursing problem in CRRT delivery, where loss of treatment time has been shown to compromise the overall dialytic efficacy [6].…”

Section: Introductionmentioning

confidence: 99%

Real-Time Circuit Pressures Correlate Poorly with Circuit Longevity in Anticoagulant-Free, Predilution Continuous Venovenous Hemofiltration

Tan

Choong

2011

Blood Purif

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Background: Continuous venovenous hemofiltration (CVVH) in renal failure is compromised by circuit clotting. We hypothesized that adverse circuit pressures are predictive of clotting in circuits that last less than 24 h during predilution, anticoagulant-free CVVH. Methods: This was a single-center retrospective study of 63 CVVH circuits of 13 critically ill intensive care unit patients with severe renal failure. Circuits were categorized into ‘clotters’ (C) or ‘nonclotters’ (NC), if spontaneous clotting occurred at <24 or ≧24 h from the start of CVVH, respectively. Results: Effluent pressures and pre-filter pressures were more adverse in NC compared to C starting from 6 and 4 h before spontaneous clotting, respectively. Arterial pressures and return pressures were not significantly different in C versus NC. Blood flow rate settings, hemofiltration fluid replacement and effluent drainage rates in C versus NC were comparable. Conclusion: Real-time circuit pressure readings seem to offer only potentially limited prognostic value in predicting circuit clotting.

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Possible Strategies to Prolong Circuit Life During Hemofiltration: Three Controlled Studies

Abstract: Neither flat plate membrane configuration nor increasing membrane surface area, nor heparin administration in the air chamber prolong circuit life during CWH. The bubble trap chamber is a frequent site of circuit clotting.

Cited by 34 publications

References 10 publications

Bubble Chamber Clotting during Continuous Renal Replacement Therapy: Vertical versus Horizontal Blood Flow Entry

Bubble Chamber Clotting during Continuous Renal Replacement Therapy: Vertical versus Horizontal Blood Flow Entry

Iloprost for Additional Anticoagulation in Continuous Renal Replacement Therapy—A Pilot Study

Real-Time Circuit Pressures Correlate Poorly with Circuit Longevity in Anticoagulant-Free, Predilution Continuous Venovenous Hemofiltration

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