The patient safety in extracorporeal blood purification treatments of critical patients

Abstract

Today, health systems are complex due to both the technological development in diagnostic and therapeutic procedures and the complexity of the patients that are increasingly older with several comorbidities. In any care setting, latent, organizational, and systematic errors can occur causing critical incident harmful for patients. Management of patients with acute kidney injury (AKI) requires a multidisciplinary approach for the diagnostic-therapeutic-rehabilitative path that can also require an extracorporeal blood purification treatment (EBPT). The complexity of these patients and EBPT require a clinical risk analysis and the introduction of protocols, procedures, operating instructions, and checklists to reduce clinical risk through promotion of the safety culture for all care providers. Caregivers must acquire a series of tools to evaluate the clinical risk in their reality to prevent incidents and customize patient safety in a proactive and reactive way. Established procedures that are made more needed by the COVID-19 pandemic can help to better manage patients in critical care area with intrinsic higher clinical risk. This review analyzes the communication and organizational aspects that need to be taken into consideration in the management of EBPT in a critical care setting by providing tools that can be used to reduce the clinical risk. This review is mostly addressed to all the caregivers involved in the EBPT in Critical Care Nephrology and in the Intensive Care Units.

Safety of Citrate Anticoagulation in CKRT: Monocentric Experience of a Dynamic Protocol of Calcium Monitoring

“…In the absence of citrate blood level monitoring and a specific checking protocol for the patient’s total and ionized calcium, the diagnosis of citrate accumulation remains relatively complex [ 15 ]. On the contrary, when a strict protocol for the patient’s safety is followed, this complication is rare [ 16 ].…”

“…The citrate removal at the filter can be impaired, resulting in excess citrate delivery to the patient, such as during CVVH with a too low ultrafiltration rate or CVVHD with an insufficient dialysate rate. If these treatments are prescribed incorrectly [ 16 ], the patient may be exposed to a higher clinical risk of citrate accumulation, especially during the sudden worsening of the patient’s clinical conditions. The strict use of a protocol for the prescription would therefore be able to avoid this complication.…”

In vitro use of standard fluid infusion central venous catheter for slow continuous ultrafiltration feasibility assessment

“…The stability of extracorporeal circulation in the range of blood flows tested was confirmed by the absence of alarms for alterations in the operating pressure in the lumen of the CVC. The stability of the extracorporeal circulation and the daily ultrafiltration volumes below 5 L reduce bag change interventions with a positive impact on nursing workload and increasing patient safety 10 . Further in vivo studies are necessary to test this technique and identify criticalities regarding the achievement of the required weight loss.…”

“…The stability of the extracorporeal circulation and the daily ultrafiltration volumes below 5 L reduce bag change interventions with a positive impact on nursing workload and increasing patient safety. 10 Further in vivo studies are necessary to test this technique and identify criticalities regarding the achievement of the required weight loss.…”