Catheter Port Reversal in Citrate Continuous Veno-Venous Hemofiltration

Boer, Willem; Tornout, Mathias van; Laenen, Margot Vander; Engelen, Kim; Meex, Ingrid; Jorens, Philippe G.

doi:10.1016/j.ekir.2021.08.006

Cited by 3 publications

(7 citation statements)

References 16 publications

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“…En cuanto a las complicaciones derivadas de la anticoagulación empleadas para evitar la coagulación del filtro y circuito 12 , todos los autores coinciden en que es necesario un ajuste estricto de la misma, tratando de evitar riesgos de hemorragia, siendo difícil conseguir un equilibrio adecuado [1][2][3][4][5][6]10,14 .…”

Section: Discussionunclassified

“…Es imprescindible para realizar las TCRR disponer de un acceso vascular que proporcione buen flujo de sangre y una baja resistencia al retorno 1,3 . La infección y la trombosis del acceso vascular son complicaciones principales asociadas.…”

Section: Identificar Las Complicaciones Más Frecuentes Derivadas Del ...unclassified

“…Respecto a la responsabilidad de la enfermera en las TCRR todas las publicaciones resaltan la importancia de la formación del personal sanitario, bien refiriéndose en general o específicamente [3][4][5]8,10 , y dos de ellas resaltan específicamente la importancia de su labor en las terapias. Yuting, Hongwiang y Zhang 7 mostraron resultados muy significativos entre un grupo personal especializado frente a uno no especializado: menos horas de interrupción (2h más en el grupo no especializado), mejor control de las complicaciones y acortamientos en el tiempo necesario de tratamiento (3 días más de TCRR en el grupo no especializado).…”

Section: Enfermería Cuidándote -Issn 2695-9364unclassified

“…El fracaso renal agudo (FRA) afecta a un 25% de los pacientes hospitalizados en las Unidades de Cuidados Intensivos, siendo esta la indicación más frecuente 2,3 . Las complicaciones asociadas a las TCRR en pacientes críticos siguen siendo elevadas a pesar de los avances tecnológicos.…”

Section: Introductionunclassified

“…No existen grandes diferencias en complicaciones según indicación específica, más allá de las derivadas de la patología de base que constituyó la decisión de inicio del procedimiento, como en pacientes sépticos con disfunción múltiple de órganos 4 . Sin embargo, si se observan complicaciones que dependen tanto de la elección de la zona de acceso vascular, como de las características del catéter utilizado 1,3 . La anticoagulación del sistema constituye un reto terapéutico en muchas ocasiones para el intensivista 5 , por los trastornos de coagulación que mucho de estos pacientes presentan al iniciar el tratamiento, la decisión del método de anticoagulación elegido también incide en complicaciones específicas 4 .…”

Section: Introductionunclassified

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Complications in continuous renal replacement techniques: a literature review

Sánchez

2023

Enferm. Cuid.

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Introduction: One of the treatments for acute renal failure is continuous renal replacement techniques, affecting 25% of patients hospitalized in intensive care units. Renal replacement techniques are considered an important technological advance to treat patients with ARF, allowing greater purifying quality and better control of complications and reducing mortality in these patients. Objective: For this reason, the main objective of this study is to analyze the most frequent complications of continuous renal replacement techniques, reviewing the scientific evidence from a nursing point of view in patients hospitalized in an intensive care unit. Method: A bibliographic search was carried out in four Health Sciences databases (PubMed, Elsevier, Ibecs and UpTodate) from which a significant number of valid articles were obtained for the review. Results: A total of 2436 articles were obtained, of which, after the exclusion criteria applied, 14 were selected for review. Conclusions: To guarantee success in continuous renal replacement techniques, it is essential to have a protocol in which the technique of the procedure carried out by the nursing staff must be collected, as well as the care required by patients, and a nursing team excellently trained in knowledge and skills, to be able to face and anticipate any type of complication in this type of therapy.

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Section: Discussionunclassified

Section: Identificar Las Complicaciones Más Frecuentes Derivadas Del ...unclassified

Section: Enfermería Cuidándote -Issn 2695-9364unclassified

Section: Introductionunclassified

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Complications in continuous renal replacement techniques: a literature review

Sánchez

2023

Enferm. Cuid.

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In an endotoxaemic model, antibiotic clearance can be affected by different central venous catheter positions, during renal replacement therapy

Bandert

Lipcsey

Frithiof

et al. 2023

ICMx

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Background In intensive care, different central venous catheters (CVC) are often used for infusion of drugs. If a patient is treated with continuous renal replacement therapy (CRRT) a second catheter, a central venous dialysis catheter (CVDC), is needed. Placing the catheters close together might pose a risk that a drug infused in a CVC could be directly aspirated into a CRRT machine and cleared from the blood without giving the effect intended. The purpose of this study was to elucidate if drug clearance is affected by different catheter placement, during CRRT. In this endotoxaemic animal model, an infusion of antibiotics was administered in a CVC placed in the external jugular vein (EJV). Antibiotic clearance was compared, whether CRRT was through a CVDC placed in the same EJV, or in a femoral vein (FV). To reach a target mean arterial pressure (MAP), noradrenaline was infused through the CVC and the dose was compared between the CDVDs. Results The main finding in this study was that clearance of antibiotics was higher when both catheter tips were in the EJV, close together, compared to in different vessels, during CRRT. The clearance of gentamicin was 21.0 ± 7.3 vs 15.5 ± 4.2 mL/min (p 0.006) and vancomycin 19.3 ± 4.9 vs 15.8 ± 7.1 mL/min (p 0.021). The noradrenaline dose to maintain a target MAP also showed greater variance with both catheters in the EJV, compared to when catheters were placed in different vessels. Conclusion The results in this study indicate that close placement of central venous catheter tips could lead to unreliable drug concentration, due to direct aspiration, during CRRT.

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Different distances between central venous catheter tips can affect antibiotic clearance during continuous renal replacement therapy

Bandert,

Lipcsey,

Frithiof

et al. 2024

ICMx

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Background The aim of this experimental study was to elucidate whether different distances between central venous catheter tips can affect drug clearance during continuous renal replacement therapy (CRRT). Central venous catheters (CVCs) are widely used in intensive care patients for drug infusion. If a patient receives CRRT, a second central dialysis catheter (CDC) is required. Where to insert CVCs is directed by guidelines, but recommendations regarding how to place multiple catheters are scarce. There are indications that a drug infused in a CVC with the tip close to the tip of the CDC, could be directly aspirated into the dialysis machine, with a risk of increased clearance. However, studies on whether clearance is affected by different CVC and CDC tip positions, when the two catheters are in the same vessel, are few. Methods In this model with 18 piglets, gentamicin (GM) and vancomycin (VM) were infused through a CVC during CRRT. The CVC tip was placed in different positions in relation to the CDC tip from caudal, i.e., proximal to the heart, to cranial, i.e., distal to the heart. Serum and dialysate concentrations were sampled after approximately 30 min of CRRT at four different positions: when the CVC tip was 2 cm caudally (+ 2), at the same level (0), and at 2 (− 2) and 4 (− 4) cm cranially of the tip of the CDC. Clearance was calculated. A mixed linear model was performed, and level of significance was set to p < 0.05. Results Clearance of GM had median values at + 2 cm, 0 cm, − 2 cm and − 4 cm of 17.3 (5.2), 18.6 (7.4), 20.0 (16.2) and 26.2 (12.2) ml/min, respectively (p = 0.04). Clearance of VM had median values at + 2 cm, 0 cm, − 2 cm and − 4 cm of 16.2 (4.5), 14.7 (4.9), 19.0 (10.2) and 21.2 (11.4) ml/min, respectively (p = 0.02). Conclusions The distance between CVC and CDC tips can affect drug clearance during CRRT. A cranial versus a caudal tip position of the CVC in relation to the tip of the CDC led to the highest clearance.

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Catheter Port Reversal in Citrate Continuous Veno-Venous Hemofiltration

Cited by 3 publications

References 16 publications

Complications in continuous renal replacement techniques: a literature review

Complications in continuous renal replacement techniques: a literature review

In an endotoxaemic model, antibiotic clearance can be affected by different central venous catheter positions, during renal replacement therapy

Different distances between central venous catheter tips can affect antibiotic clearance during continuous renal replacement therapy

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