Discuss briefly the advantages and limitations of four ( 4) strategies you would use for prevention of clotting in a continuous renal replacement therapy circuit. (You may tabulate your answer.)
Advantages |
Limitations |
|
Systemic heparin (low to medium dose) |
Easy to administer, cheap, |
Anticoagulation with this |
Regional heparin (pre |
More complex to administer, monitoring, allergy to protamine |
|
LMWheparin |
Easy to use, expensive, useful if patients has associated HITTS |
Need to measure Xa levels. |
Regional Citrate (pre |
Very effective, can be used |
Clinician unfamiliarity, |
Prostacyclin |
Useful if patient has |
Hypotensio platelet |
Heparinoids |
Useful if patient has associated HITTS |
Non pharmacological measures to consider include checking the integrity of the
catheter, avoiding kinking of the catheter and predilution.
This question vaguely resembles Question 4 from the second paper of 2010. While asking more specifically about HITS, it is answered by a huge table titled "Methods of Prolonging the CVVHDF Filter Lifespan". That table is well suited to answering this question, and I will reproduce it here.
Strategy | Advantages | Disadvantages |
Nothing whatsoever (+/- regular saline flushes) |
|
|
High flow rate |
|
|
Pre-dilution |
|
|
Unfractionated heparin |
|
|
Regional anticoagulation with heparin and protamine |
|
|
Low molecular weight heparin |
|
|
Warfarin |
|
|
Platelet function inhibitors: NSAIDs, aspirin, etc |
|
|
Citrate |
|
|
Direct thrombin inhibitors: Hirudin / Lepirudin Bivalirudin / Argatroban |
|
|
Heparinoids (Danaparoid) |
|
|
Xa inhibitors: Fondaparinux |
|
|
Serine protease inhibitors: Nafamostat |
|
|
Prostacyclin (PGI2) |
|
|
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