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

Yonglin Weng1, Fang Zhou1, Yueqiang Fu1

  • 1Intensive Care Unit, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Children Development and Disorders, International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China.

Blood Purification
|February 5, 2020
PubMed

Insights

Citrate self-circulation anticoagulation protocol (CSAP) offers a safe and effective method to maintain continuous renal replacement therapy (CRRT) in critically ill children during treatment interruptions. This approach ensures continuity without compromising patient safety or altering key physiological parameters.

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.
Abstract

Keywords:
CitrateContinuous renal replacement therapyPediatricProtocolSelf-circulation anticoagulation

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