Citrate-Based Self-Circulation Anticoagulation Protocol for Discontinuity of Continuous Renal Replacement Therapy

Area of Science:

• Pediatric Nephrology
• Critical Care Medicine
• Pharmacology

Background:

• Continuous renal replacement therapy (CRRT) is vital for critically ill children but often requires interruption for procedures.
• Discontinuities in CRRT can disrupt treatment efficacy and patient stability.

Purpose of the Study:

• To evaluate a citrate self-circulation anticoagulation protocol (CSAP) for maintaining CRRT continuity during treatment interruptions in pediatric patients.
• To assess the safety and feasibility of CSAP in this vulnerable population.

Main Methods:

• A prospective observational study involving 57 pediatric patients and 88 CRRT sessions.
• CSAP was implemented using a specific sodium citrate and saline regimen during treatment gaps.
• In-line pressures, blood counts, electrolytes, and blood gas parameters were monitored before, during, and after CSAP.

Main Results:

• CSAP averaged 118.5 minutes without significant changes in arterial, venous, or transmembrane pressures.
• No significant decrease in blood cell counts was observed during CSAP.
• Key electrolyte levels (calcium ratio, Na+, HCO3-) and pH remained stable throughout CSAP.

Conclusions:

• Citrate self-circulation anticoagulation protocol (CSAP) is a safe and effective strategy for managing CRRT discontinuity in pediatric critical care.
• CSAP provides a feasible solution to maintain treatment continuity, minimizing disruptions and ensuring patient stability.