Reversed connection of cuffed, tunneled, dual-lumen catheters with increased blood flow rate maintains the adequacy of delivered dialysis despite the higher access recirculation

Kousoula, Varvara; Georgianos, Panagiotis I.; Mavromatidis, Konstantinos; Syrganis, Christos; Thodis, Elias; Panagoutsos, Stylianos; Passadakis, Ploumis

doi:10.1007/s11255-019-02268-1

Cited by 5 publications

(4 citation statements)

References 17 publications

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“…During this period, CRRT switched to the replacement state with only the blood pump running to decrease the citrate concentration of the circuit line. Previous studies have reported that access recirculation rate was below 5% with a correct connection, but increased to 13% with a reversed connection 13,14,21,22 . Increased access recirculation due to reversed lines could impair dialysis adequacy and test accuracy of blood samples from the circuit lines.…”

Section: Discussionmentioning

confidence: 98%

“…Previous studies have reported that access recirculation rate was below 5% with a correct connection, but increased to 13% with a reversed connection. 13,14,21,22 Increased access recirculation due to reversed lines could impair dialysis adequacy and test accuracy of blood samples from the circuit lines. Citrate might chelate more calcium due to increased access recirculation in reversed lines, leading to a lower calcium concentration in the blood sampled from the circuit line than that from the CVC line.…”

Section: Discussionmentioning

confidence: 99%

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Reliability of monitoring acid‐base and electrolyte parameters through circuit lines during regional citrate anticoagulation‐continuous renal replacement therapy

Wang

Dai

Zhao

et al. 2021

Nursing in Critical Care

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Background: The current practice involves blood sampling from the circuit line to measure acid-base and electrolyte parameters during continuous renal replacement therapy (CRRT). However, there is limited evidence supporting its reliability due to the effects of anticoagulant mechanism and access recirculation associated with regional citrate anticoagulation (RCA).Aim: To evaluate the reliability of monitoring acid-base and electrolyte parameters through circuit lines in regular and reversed connections during RCA-CRRT. Study design:In this prospective cohort study, we included critically ill patients receiving RCA-CRRT via a double-lumen catheter. During the second hour after CRRT initiation, we collected blood samples to monitor acid-base and electrolyte parameters and their levels were compared between samples from the circuit lines (at 0, 3, and 5 minutes) and those from the central venous catheter (CVC) line (at 0 minute). During this time, CRRT switched to the replacement state as controls. Results:We observed 128 CRRT circuits in 60 adult patients receiving RCA-CRRT.Ninety-eight (76.6%) circuits had regular connections, while 30 (23.4%) had reversed connections. Among regular connections, no differences were observed in any acidbase or electrolyte parameters between samples from the CVC line and those from the circuit line at all time points (P > .05). Among reversed connections, ionized calcium levels were dramatically decreased at all three time points in samples from the circuit line compared with those from the CVC line (0.65 ± 0.12, 0.72 ± 0.11, and 0.78 ± 0.99 vs 0.98 ± 0.07 mmol/L, P < .001), with comparable levels of other acidbase or electrolyte parameters between the sampling patterns (P > .05).Conclusions: Acid-base and electrolyte parameters could be reliably monitored through the circuit line during RCA-CRRT in regular connections. However, in reversed connections, pre-filter ionized calcium concentrations determined through the circuit line were lower than those determined through the CVC line.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Reliability of monitoring acid‐base and electrolyte parameters through circuit lines during regional citrate anticoagulation‐continuous renal replacement therapy

Wang

Dai

Zhao

et al. 2021

Nursing in Critical Care

View full text Add to dashboard Cite

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“…The BFR is one of the most important factors in determining an appropriate Kt/V [ 13 ]. The DOPPS showed that the BFR varies depending on country [ 14 ]; thus, the optimal BFR is unclear.…”

Section: Discussionmentioning

confidence: 99%

Effect of increased blood flow rate on renal anemia and hepcidin concentration in hemodialysis patients

et al. 2021

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Background Increasing the blood flow rate (BFR) is a useful method for increasing Kt/V and the clearance for low molecular solutes. Hemodialysis patients are often anemic due to hypoerythropoiesis and their chronic inflammatory state. Hepcidin, a hormone that regulates iron homeostasis, is considered as an indicator of iron deficiency in patients with end-stage renal disease. This study aimed to investigate the effects of an increased BFR during hemodialysis on serum hepcidin levels and anemia. Methods Between April 2014 and March 2016, 22 chronic dialysis patients (11 men [50.0 %]; mean [± standard deviation] age, 72 ± 12 years) undergoing maintenance hemodialysis treatment, thrice weekly, were enrolled and followed prospectively for 24 months. In April 2014, the BFR was 200 mL/min; in April 2015 this was increased to 400 mL/min, which was within acceptable limits. The dialysate flow rate remained stable at; 500mlL/min. Blood samples were collected in March 2015 and 2016. The primary endpoint was the comparison of the amounts of erythropoiesis-stimulating agent (ESA) required. Results The increased BFR increased the Kt/V and contributed to significantly decreased urea nitrogen (UN) (p = 0.015) and creatinine (Cr) (p = 0.005) levels. The dialysis efficiency was improved by increasing the BFR. Ferritin (p = 0.038), hepcidin (p = 0.041) and high-sensitivity interleukin-6 (p = 0.038) levels were also significantly reduced. The ESA administered was significantly reduced (p = 0.004) and the Erythropoietin Resistant Index (ERI) significantly improved (p = 0.031). The reduction rates in UN (p < 0.001), Cr (p < 0.001), and beta-2 microglobulin (p = 0.017) levels were significantly greater post the BFR increase compared to those prior to the BFR increase. However, hepcidin was not affected by the BFR change. Conclusions Increasing BFR was associated with hemodialysis efficiency, and led to reduce inflammatory cytokine interleukin-6, but did not contribute to reduce C-reactive protein. This reduced hepcidin levels, ESA dosage and ERI. Hepcidin levels were significantly correlated with ferritin levels, and it remains to be seen whether reducing hepcidin leads to improve ESA and iron availability during anemia management.

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“…Some studies have suggested that higher morbidity and mortality rates have been associated with patients using lower dialysis flow rates [14][15][16]. The standard dialysis flow rate through the CVC should be at least 300 mL/min [17] although, for some catheters type, this value can reach 500 mL/min [18]. To achieve adequate effectiveness during an average dialysis treatment of 4 hours, a minimum CVC blood pump flow rate of 100 to 300 mL/min is necessary [19,20].…”

Section: Introductionmentioning

confidence: 99%

Dialysis flow rate in central venous catheters – A numerical analisys with experimental validation.

Gonçalves

Costa

Silva

et al. 2023

Preprint

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Despite a great number of studies regarding the favorable correlation between higher dialysis dose and the clinical efficiency of the hemodialysis treatment, the effect dialyses flow rate inside the catheter has been few investigated in the perspective of the hemodynamics modifications in central venous access for hemodialysis. This study proposes the numerical simulation and na in-vitro experimental validation of this model to assess the hemodynamic behavior and the thrombogenic potential in central venous access for hemodialysis, using different flow rates values in the central venous catheter (200, 250, 300, 350 and 400 mL/min). A mathematical model based in the Eulerian formulation was implemented in the solver subroutine to calculate the platelet lysis index (PLI). The pressure drop values obtained by numerical and experimental models were compered in order to validate the numerical model. The maximum percentage difference between those models was less than 13%. The flow rates values of 250, 300 and 350 mL/min resulted in larger recirculation zones in the flow field. It was possible to conclude that, in general, shear stresses and turbulence intensity increased in a quadratic manner with dialysis dose. The platelet lysis index increased with the dialysis flow rate and showed higher values in instants of time associated with major recirculation zones.

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Reversed connection of cuffed, tunneled, dual-lumen catheters with increased blood flow rate maintains the adequacy of delivered dialysis despite the higher access recirculation

Cited by 5 publications

References 17 publications

Reliability of monitoring acid‐base and electrolyte parameters through circuit lines during regional citrate anticoagulation‐continuous renal replacement therapy

Reliability of monitoring acid‐base and electrolyte parameters through circuit lines during regional citrate anticoagulation‐continuous renal replacement therapy

Effect of increased blood flow rate on renal anemia and hepcidin concentration in hemodialysis patients

Dialysis flow rate in central venous catheters – A numerical analisys with experimental validation.

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