[Impact of a program designed to improve continuous renal replacement therapy stability]

Abstract

Objectives: During continuous renal replacement therapy (CRRT), circuit clotting increases nursing workload, cost of the therapy and blood loss. The aim of this study was to assess the impact of a program designed to improve CRRT stability on unexpected circuit clotting.

Study design: Retrospective and observational study.

Patients and methods: In January 2011, several changes have been adopted regarding CRRT management. Regional citrate anticoagulation, continuous hemodialysis using super high-flux membranes and a specific training for intensive care unit nurses were implemented. CRRT sessions before (year 2009 and 2010, "Before group") and after (year 2011 and 2012, "After group") were analyzed. The primary endpoint was the incidence of unexpected CRRT session end.

Results: During the study period, 401 sessions performed in 152 patients were analyzed. Sixty-three unexpected session's end (40%) occurred before and 43 (17%) after the implementation of the program (P<0.0001). Median filter life time was 33 (13-48) hours before and 55 (27-67) hours after (P<0.0001).

Conclusion: Our program designed to improve CRRT stability reduced filter losses by reducing unexpected circuit clotting.

Keywords: Anticoagulation régionale au citrate; Circuit clotting; Hemodialysis; Hemofiltration; Hémodialyse; Hémofiltration; Regional citrate anticoagulation; Thrombose de filtre; Tinuous renal replacement therapy; Épuration extrarénale.