Practical issues of regional anticoagulation during continuous renal replacement therapy
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Department of Anaesthesiology and Intensive Care, Regional Specialist Hospital in Olsztyn, Poland
Department of Anaesthesiology and Intensive Care, Faculty of Medicine, Collegium Medicum, University of Warmia and Mazury in Olsztyn, Poland
Department of Anaesthesiology and Intensive Care, University Clinical Hospital in Olsztyn, Poland
Dariusz Onichimowski   

Wojewódzki Szpital Specjalistyczny w Olsztynie, Żołnierska 18, 10-561 Olsztyn, Poland. Tel.: +48 501 173 866.
Submission date: 2018-09-17
Acceptance date: 2019-08-05
Online publication date: 2019-11-24
Pol. Ann. Med. 2020;27(1):68–72
Extracorporeal blood purification techniques have become a well-established part of routine practice in intensive care units. The issue of major concern while applying these techniques is to ensure appropriate anticoagulation to prevent the clotting of the circuit.

The aim of this paper is to present regional anticoagulation as a method which is currently used in continuous extracorporeal blood purification techniques.

Material and methods:
This work is based on the available literature and the authors’ experience.

Results and discussion:
Anticoagulation used to prevent the clotting of the circuit in extracorporeal blood purification techniques may be regional or systemic. Regional anticoagulation inhibits clotting only in the extracorporeal circuit. In this case either sodium citrate together with calcium substitution or heparin with protamine sulfate is used. Systemic anticoagulation involves the inhibition of clotting in the extracorporeal circuit and in the patient’s body. Regional citrate anticoagulation (RCA) is obtained with the use of citrate. With this technique calcium substitution is necessary in order to prevent hypocalcemia. Other possible complications include alkalosis, metabolic acidosis, hypercalcemia and hypomagnesemia. This paper presents also some practical aspects of regional anticoagulation during continuous renal replacement therapy (CRRT)

The application of RCA has contributed to a wider use of CRRT in intensive therapy units. The greatest advantage of this method is almost complete elimination of bleeding complications associated with the therapy. It enables effective blood purification in the patients in whom the use of heparins is contraindicated. This fact has found confirmation in Kidney Disease: Improving Global Outcomes (KDIGO) guidelines.

None declared.
Dariusz Onichimowski declares that he receives fee for lectures about similar subject from Fresenius Medical care. Others authors declare to have no potential conflict of interest.
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