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Continuous Renal Replacement Therapy and Anticoagulation: What Are the Options?
1Susan Dirkes is a staff nurse in the surgical intensive care unit and the progressive care unit at the University of Michigan Health System, Ann Arbor, Michigan.Rob Wonnacott is the clinical educator in the surgical intensive care unit and lead instructor for the adult CRRT program at the University of Michigan Health System. susandirkes@gmail.com.
Critical Care Nurse
|April 3, 2016
Summary
Continuous renal replacement therapy (CRRT) is vital for acute kidney injury but prone to circuit clotting. This review covers CRRT methods and anticoagulation strategies to maintain circuit patency for critical care patients.
Area of Science:
- Nephrology
- Critical Care Medicine
- Biomedical Engineering
Background:
- Continuous renal replacement therapy (CRRT) is a cornerstone treatment for acute kidney injury (AKI) in intensive care units (ICUs).
- Patients with hemodynamic instability often require CRRT due to its continuous nature.
- The large extracorporeal blood circuit used in CRRT is susceptible to clotting, posing a significant challenge to treatment delivery.
Purpose of the Study:
- To review current methods for maintaining extracorporeal circuit patency during CRRT.
- To discuss various anticoagulation strategies employed in CRRT.
- To evaluate the efficacy and implications of different anticoagulation methods for bedside critical care.
Main Methods:
- Review of existing literature on CRRT and anticoagulation techniques.
- Analysis of different anticoagulation protocols, including heparin, saline flushes, thrombin inhibitors, and citrate.
- Examination of the clinical efficacy and safety profiles of these methods.
Main Results:
- Several anticoagulation strategies exist for CRRT, each with specific benefits and drawbacks.
- Heparin, saline flushes, thrombin inhibitors, and citrate are commonly used to prevent circuit clotting.
- The choice of anticoagulation impacts treatment efficacy and patient management in the ICU.
Conclusions:
- Effective anticoagulation is crucial for successful and uninterrupted CRRT.
- Understanding the nuances of different anticoagulation methods is essential for optimizing patient care in the ICU.
- Further research may refine anticoagulation protocols for improved CRRT outcomes.
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