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Clinical review: Patency of the circuit in continuous renal replacement therapy

Michael Joannidis1 and Heleen M Oudemans-van Straaten2*

Author Affiliations

1 Medical Intensive Care Unit, Division of General Internal Medicine, Department of Internal Medicine, Medical University Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria

2 Department of Intensive Care Medicine, Onze Lieve Vrouwe Gasthuis, Oosterpark 9, 1091 AC Amsterdam, The Netherlands

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Critical Care 2007, 11:218 doi:10.1186/cc5937

Published: 12 July 2007

Abstract

Premature circuit clotting is a major problem in daily practice of continuous renal replacement therapy (CRRT), increasing blood loss, workload, and costs. Early clotting is related to bioincompatibility, critical illness, vascular access, CRRT circuit, and modality. This review discusses non-anticoagulant and anticoagulant measures to prevent circuit failure. These measures include optimization of the catheter (inner diameter, pattern of flow, and position), the settings of CRRT (partial predilution and individualized control of filtration fraction), and the training of nurses. In addition, anticoagulation is generally required. Systemic anticoagulation interferes with plasmatic coagulation, platelet activation, or both and should be kept at a low dose to mitigate bleeding complications. Regional anticoagulation with citrate emerges as the most promising method.