PMID- 29597215
OWN - NLM
STAT- MEDLINE
DCOM- 20190411
LR  - 20190411
IS  - 1662-2782 (Electronic)
IS  - 0302-5144 (Linking)
VI  - 194
DP  - 2018
TI  - Evolution of Vascular Access and Anticoagulation.
PG  - 15-24
LID - 10.1159/000485597 [doi]
AB  - Continuous renal replacement therapy (CRRT) is an important and widely used 
      adjuvant treatment in critically ill patients. However, any CRRT protocol can be 
      adhered to only when the technique is correctly installed and functioning 
      properly. Within this context, an appropriate vascular access and a safe and 
      effective circuit anticoagulation method are key requisites. The right internal 
      jugular (RIJ) vein is the preferred route for insertion with the tip of the 
      catheter placed in the right atrium. Both femoral veins offer a valuable 
      alternative access, but catheters must be longer to avoid recirculation and 
      circuit blood flow is lower as compared with that of the RIJ approach. The 
      location of the catheter is not associated with differences in bacterial 
      colonization/infection rate or filter/circuit lifespan. Adequate anticoagulation 
      is imperative to avoid a system "shutdown" due to the early clotting of the 
      filter. For a long time, unfractionated heparin (UFH) was the anticoagulant of 
      choice. UFH is associated with an increased bleeding risk and requires the use of 
      high circuit blood flows. The introduction of regional citrate anticoagulation 
      (RCA) created a paradigm change in CRRT anticoagulation. RCA can be applied 
      safely in patients with increased bleeding risk and may enhance filter and 
      circuit survival as compared with UFH. RCA requires close monitoring for 
      potentially serious metabolic side effects. Future perspectives include improved 
      catheter technology and development of novel citrate solutions with less severe 
      metabolic impact.
CI  - (c) 2018 S. Karger AG, Basel.
FAU - Honore, Patrick M
AU  - Honore PM
FAU - Spapen, Herbert D
AU  - Spapen HD
LA  - eng
PT  - Journal Article
DEP - 20180329
PL  - Switzerland
TA  - Contrib Nephrol
JT  - Contributions to nephrology
JID - 7513582
RN  - 0 (Anticoagulants)
RN  - 2968PHW8QP (Citric Acid)
SB  - IM
MH  - Anticoagulants/administration & dosage/*adverse effects
MH  - Catheters, Indwelling/adverse effects
MH  - Citric Acid/administration & dosage/*adverse effects
MH  - Equipment Failure
MH  - Humans
MH  - Jugular Veins
MH  - Renal Replacement Therapy/*methods
EDAT- 2018/03/30 06:00
MHDA- 2019/04/12 06:00
CRDT- 2018/03/30 06:00
PHST- 2018/03/30 06:00 [entrez]
PHST- 2018/03/30 06:00 [pubmed]
PHST- 2019/04/12 06:00 [medline]
AID - 000485597 [pii]
AID - 10.1159/000485597 [doi]
PST - ppublish
SO  - Contrib Nephrol. 2018;194:15-24. doi: 10.1159/000485597. Epub 2018 Mar 29.