40 Years of Continuous Renal Replacement Therapy. Группа авторов. Читать онлайн. Newlib. NEWLIB.NET

Автор: Группа авторов
Издательство: Ingram
Серия: Contributions to Nephrology
Жанр произведения: Медицина
Год издания: 0
isbn: 9783318063073
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8]. Concomitantly placed catheters, vein patency, and patient anatomy, posture, and mobility also determine the choice of catheter insertion site. Ultrasound guidance may facilitate catheter placement and reduce insertion-related complications [57].

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      Catheter Colonization and Infection Risk

      Causal analysis of 20,000 catheter days demonstrated no difference in catheter-related infection between the RIJ and the femoral site. When stratifying to body mass index, a higher femoral catheter colonization rate was observed in the highest body mass index tercile [8].

      Catheter Dysfunction

      Catheter Lock

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      Anticoagulation

      A Paradigm Shift in Anticoagulation Approach

      Prescribing RCA

      A citrate concentration of 3–5 mmol/L should be attained before the filter to reach a post-filter ionised calcium level of 0.25–0.35 mmol/L (0.8–1.3 mg/dL) [15]. This is imperative to avoid coagulation inside the filter and the circuit. Correct prescription of citrate in any protocol requires, among others, dose adjustment to blood flow. Citrate is infused either separately or added to the replacement fluid. In the latter, currently most popular option, a fixed relation between citrate flow and blood flow is not guaranteed, as the flow of the replacement fluid varies with the ultrafiltration (UF) flow and the amount of removed fluid. For instance, when UF flow decreases or when a more negative fluid balance is desired, less citrate is administered and this may precipitate early filter clotting resulting in lower filter survival time. Adding citrate to the predilution fluid can overcome this problem.