Monitoring Anticoagulation with Unfractionated Heparin on Renal Replacement Therapy. Which is the Best aPTT Sampling Site?
| Autor: | Natalia Hagău, Florin Ioan Anton, Paul Adrian Rus |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_treatment
continuous renal replacement therapy 030232 urology & nephrology 030204 cardiovascular system & hematology heparin aPTT sampling sites 03 medical and health sciences 0302 clinical medicine medicine Renal replacement therapy medicine.diagnostic_test RC86-88.9 business.industry Medical emergencies. Critical care. Intensive care. First aid General Medicine Heparin Arterial catheter Catheter Anesthesia Arterial line business Central venous catheter medicine.drug Blood sampling Partial thromboplastin time Research Article |
| Zdroj: | The Journal of Critical Care Medicine The Journal of Critical Care Medicine, Vol 6, Iss 3, Pp 159-166 (2020) |
| ISSN: | 2393-1809 |
| Popis: | Background Controlled anticoagulation is key to maintaining continuous blood filtration therapies. Objective: The study aimed to compare different blood sampling sites for activated partial thromboplastin time (aPTT) to evaluate anticoagulation with unfractionated heparin (UFH) in continuous renal replacement therapy (CRRT) and identify the most appropriate sampling site for safe patient anticoagulation and increased filter life span. Method The study was a prospective observational single-centre investigation targeting intensive care unit (ICU) patients on CRRT using an anticoagulation protocol based on patient characteristics and a weight-based modified nomogram. Eighty-four patients were included in the study. Four sampling sites were assessed: heparin free central venous nondialysis catheter (CVC), an arterial line with heparinised flush (Artery), a circuit access line (Access), and a circuit return line (Postfilter). Blood was sampled from each of four different sites on every patient, four hours after the first heparin bolus. aPTT was determined using a rapid clot detector, point of care device. Results A high positive correlation was obtained for aPTT values between CVC and Access sampling sites (r (84) =0.72; p 0.05). The aPTT values were significantly higher at Postfilter and Arterial sampling site, older than three days, compared to the CVC sampling site (p Conclusion Considering patient bleeding risks and filter life span, the optimal sampling sites for safe assessment of unfractionated heparin anticoagulation on CRRT during CVVHDF were the central venous catheter using heparin free lavage saline solution, a heparinised flushed arterial catheter not older than three days, and a circuit access line. |
| Databáze: | OpenAIRE |
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