tailieunhanh - Báo cáo y học: "Heparin algorithm for anticoagulation during continuous renal replacement therapy"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học quốc tế cung cấp cho các bạn kiến thức về ngành y đề tài: Heparin algorithm for anticoagulation during continuous renal replacement therapy. | Ostermann et al. Critical Care 2010 14 419 http content 14 3 419 CRITICAL CARE LETTER L_ Heparin algorithm for anticoagulation during continuous renal replacement therapy Marlies Ostermann Helen Dickie Linda Tovey and David Treacher Abstract Premature circuit clotting is a problem during continuous renal replacement therapy. We describe an algorithm for individualised anticoagulation with unfractionated heparin based on the patient s risk of bleeding and previous circuit life. The algorithm allows effective and safe nurse-led anticoagulation during continuous renal replacement therapy. Introduction Continuous renal replacement therapy CRRT has become an established treatment for patients with acute kidney injury in the intensive care unit ICU . Premature circuit clotting is a common problem leading to reduced circuit life to reduced clearance and also to increased blood loss work load and cost of therapy 1 . There are different ways of maintaining the circuit patent 2 . An international questionnaire showed that in the UK more than 98 of ICUs surveyed used unfractionated heparin 3 . The major advantages of unfractionated heparin are the low costs familiarity ease of administration and reversibility with protamine. CRRT is predominantly nurse-led 4 . After a decision is made to start CRRT nurses usually prepare and manage the technique. Unfractionated heparin is the first-line anticoagulant in our unit. In order to enable the nursing staff to manage CRRT effectively and safely we aimed to have clear guidelines in place including an algorithm for the use of heparin. Methods We contacted seven large ICUs in the UK and three units outside the UK. None of the ICUs contacted had a guideline for the use of unfractionated heparin during CRRT. We therefore designed an algorithm based on data Correspondence Guy s St Thomas Foundation Trust Department of Critical Care Westminster Bridge Road London SE17EH UK from the literature