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Intensive Care Medicine

, Volume 30, Issue 11, pp 2074–2079 | Cite as

Blood flow reductions during continuous renal replacement therapy and circuit life

  • Ian BaldwinEmail author
  • Rinaldo Bellomo
  • Bill Koch
Original

Abstract

Objective

Reductions in blood flow rate may occur undetected during peristaltic pumping of blood through continuous renal replacement therapy circuits. We investigated whether undetected reductions in blood flow rate occur during continuous veno-venous haemofiltration, and whether they are correlated with filter life.

Patients

Twelve patients receiving continuous veno-venous haemofiltration in the intensive care unit of a tertiary hospital.

Methods

Extracorporeal circuit blood flow during haemofiltration was continuously monitored utilizing a miniature ultrasound Doppler device. Otherwise undetected blood flow reductions were identified at severity levels of between 20% and 100% less than the set diastolic flow rate (83 ml/min). Information on anticoagulation status was simultaneously obtained. The frequency and severity of blood flow reductions were recorded, and the correlation with filter life was determined.

Measurements and results

The duration of filter life ranged from 1.5 to 53 h, with a mean functional life of 19.62±16.32 h. There were 314 episodes of blood flow reduction during the 525 h of monitoring (0.59 episodes/h). There was a significant inverse relationship between the number of medium-level blood flow reductions and filter life. This correlation was much stronger than that between APTT and filter life.

Conclusions

Undetected blood flow reductions occur during continuous veno-venous haemofiltration. Such reductions are frequent, and when sufficiently severe appear to be correlated with filter life more strongly than the blood coagulation variables typically used to monitor adequacy of anticoagulation and promote filter longevity.

Keywords

Haemofiltration Renal replacement therapy Acute renal failure Critical illness Coagulation 

References

  1. 1.
    Davenport A, Mehta S (2002) The Acute Dialysis Quality Initiative. V. Access and anticoagulation in CRRT. Adv Ren Replace Ther 9:273–281CrossRefPubMedGoogle Scholar
  2. 2.
    Shulman RI, Singer M, Rock J (2002) Keeping the circuit open: lessons from the lab. Blood Purif 20:275–281CrossRefPubMedGoogle Scholar
  3. 3.
    Tolwani A, Campbell RC, Schenk MB, Allon M, Warnock DG (2001) Simplified citrate anticoagulation for continuous renal replacement therapy. Kidney Int 60:370–374CrossRefPubMedGoogle Scholar
  4. 4.
    Gretz N, Quintel M, Ragaller M, Odenwalder W, Bender HJ, Rohmeiss SM (1995) Low-dose heparinization for anticoagulation in intensive care patients on continuous hemofiltration. Contrib Nephrol 116:130–135PubMedGoogle Scholar
  5. 5.
    Langeneker SA, Felfernig M, Werba A, Meuller CM, Chiari A, Zinpfer M (1994) Anticoagulation with prostacyclin and heparin during continuous venovenous hemofiltration. Crit Care Med 22:1774–1781PubMedGoogle Scholar
  6. 6.
    Macdonald D, Martin R (1995) Use of sodium citrate anticoagulation in a paediatric continuous venovenous hemodialysis patient. ANNA J 22:327–328PubMedGoogle Scholar
  7. 7.
    Baldwin I, Bridge N, Heland M, Bellomo R (1996) The effect of heparin administration site on extracorporeal circuit life during continuous venovenous hemofiltration. Aust Crit Care 1:29Google Scholar
  8. 8.
    Martin P-Y, Chevrolet JC, Suter P, Favre H (1994) Anticoagulation in patients treated by continuous venovenous hemofiltration: a retrospective study. Am J Kidney Dis 24:806–812PubMedGoogle Scholar
  9. 9.
    Mehta R (1996) Anticoagulation strategies for continuous renal replacement therapies: What works? Am J Kidney Dis 28 [Suppl 3]:806–812, S8–S14Google Scholar
  10. 10.
    Mehta RL, Dobos GJ, Ward DM (1992) Anticoagulation in continuous renal replacement procedures. Semin Dial 5:61–68Google Scholar
  11. 11.
    Depner TA, Rizwan S, Stasi TA (1990) Pressure effects on roller pump blood flow during hemodialysis. ASAIO Trans M456–M459Google Scholar
  12. 12.
    Snyder EJ, Harb HM, Cullen JA, McElwee L (1997) Setting roller pump occlusion with the transonic HT 109 flowmeter. ASAIO J 43:60–64PubMedGoogle Scholar
  13. 13.
    Sands J, Glidden D, Jacavage W, Jones B (1996) Difference between delivered and prescribed flow in hemodialysis. ASAIO J M717–M719Google Scholar
  14. 14.
    Baldwin I, Bellomo R, Koch B (2002) A technique for the monitoring of blood flow during continuous hemofiltration. Intensive Care Med 28:1361–1364CrossRefPubMedGoogle Scholar
  15. 15.
    Terual, Fernadez LM, Rodriguez JR, Lopez SJ, Rivera M, Liano F, Oruno J (2000) Differences between blood flow as indicated by the hemodialysis blood roller pump and blood flow as measured by an ultrasonic sensor. Nephron 85:142–147CrossRefPubMedGoogle Scholar
  16. 16.
    Noon GP, Kane LE, Feldman L, Peterson JA, DeBakey ME (1985) Reduction of blood trauma in roller pumps for long term perfusion. World Surg J 9:65–71Google Scholar
  17. 17.
    Reed CC, Stafford TB (1985) Cardiopulmonary bypass, 2nd edn. Texas Medical, HoustonGoogle Scholar

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  1. 1.Department of Intensive CareAustin HospitalHeidelbergAustralia
  2. 2.Department of Intensive Care and SurgeryMelbourne UniversityMelbourneAustralia
  3. 3.Faculty of NursingRoyal Melbourne Institute of TechnologyMelbourneAustralia

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