Regional citrate anticoagulation and influence of recirculation on ionized calcium levels in the circuit

Degraeve, Anais; Danse, Étienne; Laterre, Pierre‐François; Hantson, Philippe; Wérion, Alexis

doi:10.1007/s10047-019-01125-3

Cited by 6 publications

(6 citation statements)

References 7 publications

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“…Access recirculation might explain the discrepancy observed in the present study between the ionized calcium levels in the CVC line and those in the circuit line in reversed connections. Consistent with the results of the present study, two case reports using blood sampling from the circuit line during CRRT with RCA also showed an inevitable influence of vascular access recirculation on ionized calcium levels 18,19 . Recirculation could lead to low calcium levels in the blood circulating in the circuit.…”

Section: Discussionsupporting

confidence: 90%

“…Consistent with the results of the present study, two case reports using blood sampling from the circuit line during CRRT with RCA also showed an inevitable influence of vascular access recirculation on ionized calcium levels. 18,19 Recirculation could lead to low calcium levels in the blood circulating in the circuit. Thus, we do not recommend reversing the connection during CRRT while using RCA as an anticoagulant.…”

Section: Discussionmentioning

confidence: 99%

“…To the best of our knowledge, only two case reports have indicated that blood sampling from the circuit line during CRRT with RCA could not avoid the effects of vascular access recirculation on the determination of ionized calcium levels. 18,19 Therefore, we raised the question of the accuracy of blood sampling from the circuit line during CRRT with RCA, especially in a reversed connection.…”

Section: Introductionmentioning

confidence: 99%

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Reliability of monitoring acid‐base and electrolyte parameters through circuit lines during regional citrate anticoagulation‐continuous renal replacement therapy

Wang

Dai

Zhao

et al. 2021

Nursing in Critical Care

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Background: The current practice involves blood sampling from the circuit line to measure acid-base and electrolyte parameters during continuous renal replacement therapy (CRRT). However, there is limited evidence supporting its reliability due to the effects of anticoagulant mechanism and access recirculation associated with regional citrate anticoagulation (RCA).Aim: To evaluate the reliability of monitoring acid-base and electrolyte parameters through circuit lines in regular and reversed connections during RCA-CRRT. Study design:In this prospective cohort study, we included critically ill patients receiving RCA-CRRT via a double-lumen catheter. During the second hour after CRRT initiation, we collected blood samples to monitor acid-base and electrolyte parameters and their levels were compared between samples from the circuit lines (at 0, 3, and 5 minutes) and those from the central venous catheter (CVC) line (at 0 minute). During this time, CRRT switched to the replacement state as controls. Results:We observed 128 CRRT circuits in 60 adult patients receiving RCA-CRRT.Ninety-eight (76.6%) circuits had regular connections, while 30 (23.4%) had reversed connections. Among regular connections, no differences were observed in any acidbase or electrolyte parameters between samples from the CVC line and those from the circuit line at all time points (P > .05). Among reversed connections, ionized calcium levels were dramatically decreased at all three time points in samples from the circuit line compared with those from the CVC line (0.65 ± 0.12, 0.72 ± 0.11, and 0.78 ± 0.99 vs 0.98 ± 0.07 mmol/L, P < .001), with comparable levels of other acidbase or electrolyte parameters between the sampling patterns (P > .05).Conclusions: Acid-base and electrolyte parameters could be reliably monitored through the circuit line during RCA-CRRT in regular connections. However, in reversed connections, pre-filter ionized calcium concentrations determined through the circuit line were lower than those determined through the CVC line.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Reliability of monitoring acid‐base and electrolyte parameters through circuit lines during regional citrate anticoagulation‐continuous renal replacement therapy

Wang

Dai

Zhao

et al. 2021

Nursing in Critical Care

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“…To our knowledge the phenomenon and effects of recirculation in a citrate CVVH circuit have only been described previously in 2 case reports: the first described a pediatric patient after CathPR using a femoral line 13 , the second due to deep vein thrombosis leading to significant recirculation in a patient undergoing citrate CVVH, also via a femoral catheter 14 . In the former, CathPR was implemented because of catheter dysfunction, which is common clinical practice.…”

Section: Discussionmentioning

confidence: 99%

Catheter Port Reversal in Citrate Continuous Veno-Venous Hemofiltration

Boer¹,

Tornout²,

Laenen³

et al. 2021

Kidney International Reports

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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“…The first case was described in a child during the reversal of arterial and venous lines of the dialysis catheter placed in the femoral vein [ 2 ]. The second case involved an adult patient when a venous thrombosis was observed close to the tip of the catheter placed in the right femoral vein [ 3 ]. In our three patients, when the catheters were changed, we identified the presence of calcified material at the tip of the catheters (Fig.…”

Section: Lessons For the Clinical Nephrologistmentioning

confidence: 99%

Lessons for the clinical nephrologist: vascular access recirculation during continuous renal replacement therapy and regional citrate anticoagulation

et al. 2022

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Regional citrate anticoagulation and influence of recirculation on ionized calcium levels in the circuit

Cited by 6 publications

References 7 publications

Reliability of monitoring acid‐base and electrolyte parameters through circuit lines during regional citrate anticoagulation‐continuous renal replacement therapy

Reliability of monitoring acid‐base and electrolyte parameters through circuit lines during regional citrate anticoagulation‐continuous renal replacement therapy

Catheter Port Reversal in Citrate Continuous Veno-Venous Hemofiltration

Lessons for the clinical nephrologist: vascular access recirculation during continuous renal replacement therapy and regional citrate anticoagulation

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