Regional Citrate Anticoagulation: Beware of Recirculation Phenomenon

Chenouard, Alexis; Liet, Jean-Michel

doi:10.1111/1744-9987.12505

Cited by 4 publications

(7 citation statements)

References 4 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%

“…Moreover, caregivers should be extremely careful in modifying the setting of the RCA protocol when calcium levels are measured from the circuit line. 19 In clinical practice, it is critical to monitor the acid-base and electrolyte parameters during CRRT. 23 Nursing time is mostly devoted to blood sampling and essential parameter monitoring during CRRT with RCA.…”

Section: Discussionmentioning

confidence: 99%

“…However, ionized calcium could be chelated by citrate anticoagulation when blood is sampled from the circuit line during CRRT with RCA and the reliability of monitoring electrolytes, particularly ionized calcium, has rarely been discussed with respect to access recirculation. 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: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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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show abstract

“…Two similar cases during CRRT and regional citrate anticoagulation have been described in the literature. 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 ].…”

Section: Lessons For the Clinical Nephrologistmentioning

confidence: 99%