Читать книгу 40 Years of Continuous Renal Replacement Therapy - Группа авторов - Страница 32

When not in use, the CRRT catheter should be locked either by controlled saline infusion or by heparin or citrate provision to prevent fibrin adhesion [11]. A 30% citrate solution guarantees optimal patency of the catheter at the lowest bleeding risk. It also reduces the risk for Staphylococcus and Candida catheter sepsis by inhibiting biofilm formation inside the catheter [12].

Fig. 2. Clinical algorithm to avoid early clotting of continuous renal replacement therapy (CRRT; adapted and modified from Gainza et al. [16] with permission) [9]. UFH, unfractionated heparin; AT III, anti-thrombin III; aPTT, activated partial thromboplastin time; INR, internationalized ratio; DIC, disseminated intravascular coagulopathy; ACD, anticoagulant citrate dextrose. AT III level above 60%. aPTT between 45 and 55 s. Prostacyclin always in association with UFH at a 5 times lower dose (1–2 U/kg/h).