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Citrate anticoagulation in pediatric continuous venovenous hemofiltration
Nahum Elhanan1, Peter Skippen, Gabrielle Nuthall
1Intensive Care Unit, Children's and Women's Health Centre of British Columbia, 4480 Oak Street, V6H 3V4, Vancouver, British Columbia, Canada.
Pediatric Nephrology (Berlin, Germany)
|December 12, 2003
Summary
Regional citrate anticoagulation is a safe and effective alternative to heparin for critically ill children undergoing continuous venovenous hemofiltration (CVVH). This method provides good filter survival and avoids bleeding complications, with manageable metabolic effects.
Area of Science:
- Pediatric Intensive Care
- Nephrology
- Critical Care Medicine
Background:
- Regional citrate anticoagulation (RCA) is increasingly used in adults for continuous venovenous hemofiltration (CVVH).
- Limited data exists on RCA's efficacy and safety in critically ill pediatric patients.
Purpose of the Study:
- To evaluate the safety and effectiveness of RCA in critically ill children undergoing CVVH.
- To assess filter survival, metabolic parameters, and complications associated with RCA in this population.
Main Methods:
- Retrospective chart review of nine critically ill children treated with CVVH using RCA and systemic calcium replacement.
- Analysis of patient characteristics, CVVH circuit parameters, filter survival, and laboratory values (including citrate levels).
- Interviews with nursing staff regarding practical management.
Main Results:
- Good control of azotemia and hyperkalemia was achieved.
- Sodium and ionized calcium levels were well-maintained; elevated bicarbonate was observed in some patients without adverse effects.
- Mean filter survival was 55.6 hours, comparable to heparin, with no systemic bleeding complications.
Conclusions:
- Regional citrate anticoagulation is a safe and effective anticoagulation strategy for pediatric CVVH.
- It offers comparable filter survival to heparin without the risk of bleeding complications.
- With adequate staff preparation, RCA is a feasible and safe option for critically ill children, with manageable metabolic side effects.