Background: The continuous renal replacement therapy (CRRT) bubble trap chamber is a frequent site of clotting. Aims: To assess clot formation when comparing our standard ‘vertical’ blood entry chamber (BEC) with a new ‘horizontal’ BEC. Methods: Adult ICU patients requiring CRRT were treated with the vertical BEC and then a similar subsequent cohort with the horizontal BEC in continuous veno-venous haemofiltration mode. Results: 40 chambers were assessed for each design. Circuit life was 13.9 ± 9.5 h for the vertical and 17.7 ± 15.9 h for the horizontal BEC (p = 0.33). APTT, however, was higher for the horizontal BEC (55.7 ± 34.7 vs. 37.4 ± 9.0, p < 0.002) and no difference in circuit life was found after multivariable analysis. A clotting score ≥3 was observed in 85% of all chambers. There was no difference in chamber clotting score (vertical 3.6 ± 1.03 vs. horizontal 3.8 ± 1.0, p = 0.5). In addition, no difference was found when scores were divided into two groups using a ‘likelihood’ to clot analysis (p = 1.0). Conclusion: CRRT horizontal BEC were not associated with less clotting compared to our standard vertical BEC.

Keywords:
Continuous renal replacement therapy, ICU, Haemofiltration, Acute renal failure, Bubble trap, Clotting
1.
Madhukar M: The basics of haemodialysis equipment. Haemodial Int 2005;9:30–36.
2.
Baldwin I: Factors affecting circuit patency and filter life. Contrib Nephrol. Basel, Karger, 2007, vol 156, pp 178–184.
3.
Holt AW, Bierer P, Bersten AD, Bury LK, Vedig AE: Continuous renal replacement therapy in critically ill patients: monitoring circuit function. Anaesth Intens Care 1996;24:423–429.
4.
Baldwin I, Tan HK, Bridge N, Bellomo R: Possible strategies to prolong circuit life during hemofiltration: three controlled studies. Renal Fail 2002;24:839–848.
5.
Baldwin I C, Elderkin TD: CVVH in intensive care: nursing perspectives. New Horizons 1995;3:738–747.
6.
Gretz N, Quintel M, Ragaller M, Odenwalder W, Bender HJ, Rohmeiss P, Strauch M: Low-dose heparinization for anticoagulation in intensive care patients on continuous hemofiltration. Contrib Nephrol. Basel, Karger, 1995, vol 116, pp 130–135.
7.
Ward MK, Shadforth M, Hill AVL, Kerr DNS: Air embolism during haemodialysis. Br Med J 1971;3:74–78.
8.
Sutherland AC: The engineering design of haemodialysis equipment. Ann R Coll of Surg Engl 1970;46:350–356.
9.
Davies H, Leslie G: Maintaining the CRRT circuit: non-anticoagulant alternatives. Austr Crit Care 2006;19:133–138.
10.
Webb AR, Mythen MG, Jacobson D, Mackie IJ: Maintaining blood flow in the extracorporeal circuit: haemostasis and anticoagulation. Intens Care Med 1995;21:84–93.
11.
Davenport A: The coagulation system in the critically ill patient with acute renal failure and the effect of an extracorporeal circuit. Am J Kidn Dis 1997;30(suppl 4):s20–s27.
12.
Ricci Z, Bonello M, Salvatori G, Ratanarat R, Brendolan A, Dan M, Ronco C: Continuous renal replacement technology: from adaptive devices to flexible multipurpose machines. Crit Care Resus 2004;6:180–187.
13.
Uchino S, Fealy N, Baldwin I, Morimatsu H, Bellomo R: Pre-dilution vs. post-dilution during continuous veno-venous hemofiltration: impact on filter life and azotemic control. Nephron Clin Pract 2003;94:94–98.
© 2012 S. Karger AG, Basel
2012
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.