Читать книгу 40 Years of Continuous Renal Replacement Therapy - Группа авторов - Страница 37

Vascular access and anticoagulation for CRRT have considerably evolved over the years. Dialysis catheters are preferentially placed in the RIJ vein with the tip positioned in the right atrium. Ultrasound guidance may assist in placing the catheter. Femoral vein catheterization is a valuable alternative. Future improvements in catheter “technology” and performance are awaited, in particular for use in combined extracorporeal techniques (e.g., low flow extracorporeal CO₂ removal embedded in a CRRT circuit).

RCA has revolutionized anticoagulation by allowing lower circuit blood flow, causing less bleeding accidents, and creating better filter performance. However, implementing RCA requires careful monitoring, including early detection and anticipation of potential citrate-related metabolic complications. Novel citrate solutions are being developed that will allow more optimal metabolic fine-tuning.