<abstract xmlns="http://www.w3.org/1999/xhtml"><sec id="j_jccm-2020-0024_s_007_w2aab3b7c15b1b6b1aab1c16b1Aa"><h3>Background</h3><p>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.</p></sec><sec id="j_jccm-2020-0024_s_008_w2aab3b7c15b1b6b1aab1c16b2Aa"><h3>Method</h3><p>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.</p></sec><sec id="j_jccm-2020-0024_s_009_w2aab3b7c15b1b6b1aab1c16b3Aa"><h3>Results</h3><p>A high positive correlation was obtained for aPTT values between CVC and Access sampling sites (r (84) =0.72; p &lt;0 .05) and a low positive correlation between CVC and Arterial sampling site (r (84) =0.46, p &lt; 0.05). When correlated by artery age, the young Artery (1-3 day old) correlates with CVC, Access and Postfilter (r (45) = 0.74, 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&lt;0.05).</p></sec><sec id="j_jccm-2020-0024_s_010_w2aab3b7c15b1b6b1aab1c16b4Aa"><h3>Conclusion</h3><p>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.</p></sec></abstract>

BackgroundControlled 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.MethodThe 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.ResultsA high positive correlation was obtained for aPTT values between CVC and Access sampling sites (r (84) =0.72; p <0 .05) and a low positive correlation between CVC and Arterial sampling site (r (84) =0.46, p < 0.05). When correlated by artery age, the young Artery (1-3 day old) correlates with CVC, Access and Postfilter (r (45) = 0.74, 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<0.05).ConclusionConsidering 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.

Monitoring Anticoagulation with Unfractionated Heparin on Renal Replacement Therapy. Which Is the Best aPTT Sampling Site?

The Journal of Critical Care Medicine

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

BackgroundControlled 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.MethodThe 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.ResultsA 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<0.05).ConclusionConsidering 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.

BackgroundControlled anticoagulation is key to maintaining continuous blood filtration therapies. Objective: The study aimed to compare different blood...

Plasma aPTT found	Continuous rate action	Bolus	Check time
Plasma aPTT <35 sec	+ 4 UI/Kg/h	Rebolus 50 UI/Kg	aPTT afte (3h)
Plasma aPTT 35 - 45 sec	+ 2 UI/Kg/h	Rebolus 20 UI/Kg	aPTT after (3h)
Plasma aPTT 46 - 60 sec	+ 2 UI/Kg/h	-	aPTT after (3h)
Plasma aPTT 60 - 70 sec	-	-	aPTT after (4h)
Plasma aPTT 71 - 90 sec	- 2 UI/Kg/h	-	aPTT after (3h)
Plasma aPTT > 90 sec	- 3 UI/Kg/h	Stop Cont. inf 60 min	aPTT after (2h)

	Variables (sec.)	1	2	3	4
1	CVC	-	0.80 ^(r)	0.71 ^(r)	0.75 ^(r)
2	Access	0.80 ^(r)	-	0.62 ^(r)	0.67^(r)
3	Postfilter	0.71 ^(r)	0.62 ^(r)	-	0.57^(r)
4	Artery	0.75 ^(r)	0.67 ^(r)	0.57 ^(r)

aPTT values for patients with Artery age between 4 to 6 days---- (n=39)

	Variables	1	2	3	4
1	CVC (sec.)	-	0.72 ^(r)	0.69 ^(r)	0.46 ^(r)
2	Access (sec.)	0.72 ^(r)	-	0.62 ^(r)	0.43 ^(r)
3	Postfilter (sec.)	0.69 ^(r)	0.62 ^(r)	-	0.47 ^(r)
4	Artery (sec.)	0.46 ^(r)	0.43 ^(r)	0.47 ^(r)	-

All patients group (84)	Mean (SD)	p value
Access (sec.)	73 (±20)	p = 0.74
Posftilter (sec.)	92 (±19)	p < 0.01	75 (±18)
Artery (sec.)	82 (±18)	p < 0.01

Monitoring Anticoagulation with Unfractionated Heparin on Renal Replacement Therapy. Which Is the Best aPTT Sampling Site?

Article Category: Research Article

Data publikacji: 11 sie 2020

Zakres stron: 159 - 166

Otrzymano: 25 lut 2020

Przyjęty: 26 cze 2020

DOI: https://doi.org/10.2478/jccm-2020-0024

Słowa kluczowe
continuous renal replacement therapy, heparin, aPTT sampling sites

© 2020 Florin Ioan Anton, Paul Adrian Rus, Natalia Hagau, published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Fig. 1

Protocol for bolus and dose adjustment when using UFH on CRRTModified unfractionated weight-based heparin nomogramTarget: aPTT x2 Initial Dose (Bolus) 50 UI/Kg * Maintenance 10 - 15 UI/Kg/H

Correlations and Descriptive Statistics depending on artery ageaPTT values for patients with Artery younger than 3 days ---- (n=45)

Correlations and Descriptive Statistics (N = 84) - aPTT values for CVC, Access, Postfilter and Artery

Comparison of CVC, Access, Postfilter and Artery aPTT values

Monitoring Anticoagulation with Unfractionated Heparin on Renal Replacement Therapy. Which Is the Best aPTT Sampling Site?

Article Category: Research Article

Data publikacji: 11 sie 2020

Zakres stron: 159 - 166

Otrzymano: 25 lut 2020

Przyjęty: 26 cze 2020

DOI: https://doi.org/10.2478/jccm-2020-0024

Słowa kluczowecontinuous renal replacement therapy, heparin, aPTT sampling sites

© 2020 Florin Ioan Anton, Paul Adrian Rus, Natalia Hagau, published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Fig. 1

Protocol for bolus and dose adjustment when using UFH on CRRTModified unfractionated weight-based heparin nomogramTarget: aPTT x2 Initial Dose (Bolus) 50 UI/Kg * Maintenance 10 - 15 UI/Kg/H

Correlations and Descriptive Statistics depending on artery ageaPTT values for patients with Artery younger than 3 days ---- (n=45)

Correlations and Descriptive Statistics (N = 84) - aPTT values for CVC, Access, Postfilter and Artery

Comparison of CVC, Access, Postfilter and Artery aPTT values

Słowa kluczowe
continuous renal replacement therapy, heparin, aPTT sampling sites