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CRRT Regional Anticoagulation Using Citrate in the Liver Failure and Liver Transplant Population.
- Source :
-
Critical care nursing quarterly [Crit Care Nurs Q] 2016 Jul-Sep; Vol. 39 (3), pp. 241-51. - Publication Year :
- 2016
-
Abstract
- Regional citrate for continuous renal replacement therapy (CRRT) use in patients with liver failure or post-liver transplant has been considered a contraindication because of the risk of citrate toxicity development. Regional citrate has the benefit of decreased bleeding risks over systemic anticoagulation; therefore, it is of great benefit to the coagulopathic and surgical populations. This article analyzes current empiric data and compares with a case study specifically related to liver failure, liver transplant, and CRRT use. We found that the use of a total serum to ionized calcium ratio was much more reliable in measuring liver function than liver enzyme figures. This when paired with a citrate-reduction guideline based on serum to ionized calcium ratios provided effective, early management of citrate toxicity. Using new measurements to calculate liver metabolism of citrate and using a new citrate-reducing guideline allow the bedside practitioner to use regional citrate anticoagulation in patients with liver failure and liver transplant who require CRRT.
Details
- Language :
- English
- ISSN :
- 1550-5111
- Volume :
- 39
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- Critical care nursing quarterly
- Publication Type :
- Academic Journal
- Accession number :
- 27254640
- Full Text :
- https://doi.org/10.1097/CNQ.0000000000000118