Research progress on saline flushing extracorporeal circulation line during continuous renal replacement therapy without anticoagulation_West China Medical Journal

Authors：

SUN Xiankun ¹ , WANG Fang ² , CHEN Zhiwen ² ,  ZHANG Ling ²

1. Department of Nephrology and Kidney Research Institute, West China Hospital, Sichuan University / West China School of Nursing, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Department of Nephrology and Kidney Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

ZHANG Ling, Email: zhangling_crrt@163.com

Keywords：

Continuous renal replacement therapy; saline flush; review

DOI：

10.7507/1002-0179.202306153

Video：

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Because existing anticoagulants may have contraindications and side effects, continuous renal replacement therapy (CRRT) without anticoagulants is nevertheless widely used. Although it does not produce major adverse effects without anticoagulant CRRT, it can raise the risk of clotting, which can lead to treatment cessation. Extracorporeal circulation lines with saline flush are frequently utilized as a non-pharmaceutical anticoagulation strategy. However, in the absence of anticoagulant CRRT, its clinical efficacy remains debatable. Therefore, this article reviews the specific procedures, flushing frequency, flushing effect, and adverse events of flushing extracorporeal circulation lines with normal saline when CRRT is free anticoagulant, generating fresh ideas for future research.

Citation： SUN Xiankun, WANG Fang, CHEN Zhiwen, ZHANG Ling. Research progress on saline flushing extracorporeal circulation line during continuous renal replacement therapy without anticoagulation. West China Medical Journal, 2023, 38(7): 1073-1076. doi: 10.7507/1002-0179.202306153 Copy

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2.	Brandenburger T, Dimski T, Slowinski T, et al. Renal replacement therapy and anticoagulation. Best Pract Res Clin Anaesthesiol, 2017, 31(3): 387-401.
3.	Nagarik AP, Soni SS, Adikey GK, et al. Comparative study of anticoagulation versus saline flushes in continuous renal replacement therapy. Saudi J Kidney Dis Transpl, 2010, 21(3): 478-483.
4.	Karkar A, Ronco C. Prescription of CRRT: a pathway to optimize therapy. Ann Intensive Care, 2020, 10(1): 32.
5.	Zhang W, Bai M, Yu Y, et al. Continuous renal replacement therapy without anticoagulation in critically ill patients at high risk of bleeding: a systematic review and meta-analysis. Semin Dial, 2021, 34(3): 196-208.
6.	Tsujimoto Y, Miki S, Shimada H, et al. Non-pharmacological interventions for preventing clotting of extracorporeal circuits during continuous renal replacement therapy. Cochrane Database Syst Rev, 2021, 9(9): CD013330.
7.	Macedo E, Mehta RL. Continuous dialysis therapies: core curriculum 2016. Am J Kidney Dis, 2016, 68(4): 645-657.
8.	Zimbudzi E. Intermittent saline flushes or continuous saline infusion: what works better when heparin-free dialysis is recommended?. Int J Nephrol Renovasc Dis, 2013, 6: 65-69.
9.	Lim EK, Seow YT, Chen SE, et al. Simple citrate anticoagulation protocol for low flux haemodialysis. BMC Nephrol, 2018, 19(1): 16.
10.	Sanz M, Hidalgo F, García-Fernández N. Circuit life span of continuous renal replacement therapy in critically ill patients with or without conventional anticoagulation: an observational prospective study. An Sist Sanit Navar, 2017, 40(1): 77-84.
11.	Szymczak A, Kanafa M, Chuć M, et al. Heparin-free hemodialysis. Postepy Hig Med Dosw, 2018, 72: 671-677.
12.	Panphanpho S, Naowapanich S, Ratanarat R. Use of saline flush to prevent filter clotting in continuous renal replacement therapy without anticoagulant. J Med Assoc Thai, 2011, 94 (Suppl 1): S105-S110.
13.	Acar E, Cicek HS. The effect of different intermittent intervals of flushing extracorporeal circuits to dialysis adequacy and vital signs in heparin free hemodialysis. Int J Caring Sci, 2018, 11(1): 196-202.
14.	Davies H, Leslie G. Maintaining the CRRT circuit: non-anticoagulant alternatives. Aust Crit Care, 2006, 19(4): 133-138.
15.	郭宏晶, 李莉, 向晶, 等. 日间无抗凝 CRRT 患者体外循环管路冲洗护理的研究. 中国血液净化, 2017, 16(9): 635-642.
16.	陈香美. 血液净化标准操作规程. 北京: 人民卫生出版社, 2021.
17.	Guéry B, Alberti C, Servais A, et al. Hemodialysis without systemic anticoagulation: a prospective randomized trial to evaluate 3 strategies in patients at risk of bleeding. PLoS One, 2014, 9(5): e97187.
18.	张仲华, 曾铁英, 黄博伦, 等. 无抗凝连续性肾脏替代治疗体外循环装置使用时间影响因素的研究. 护理学杂志, 2019, 34(13): 22-27.
19.	Brain M, Winson E, Roodenburg O, et al. Non anti-coagulant factors associated with filter life in continuous renal replacement therapy (CRRT): a systematic review and meta-analysis. BMC Nephrol, 2017, 18(1): 69.
20.	向泳燕, 郭锦丽, 张颖惠, 等. CRRT 体外循环寿命非抗凝危险因素的 Meta 分析. 护理研究, 2023, 37(1): 160-165.
21.	黄显莉, 张胜, 林丽, 等. 盐水冲洗对连续性肾脏替代治疗体外循环寿命及溶质清除的影响. 华西医学, 2022, 37(9): 1314-1321.
22.	中华医学会肾脏病学分会专家组. 连续性肾脏替代治疗的抗凝管理指南. 中华肾脏病杂志, 2022, 38(11): 1016-1024.
23.	黄卓凡, 陈巧玲, 陈钗英, 等. 不同冲洗方式在无抗凝连续性肾脏替代治疗中的效果分析. 全科护理, 2021, 19(3): 354-358.
24.	阮宏兵. 无肝素抗凝连续肾脏替代治疗中滤器冲洗的研究. 济南: 山东大学, 2015.
25.	Dirkes S, Wonnacott R. Continuous renal replacement therapy and anticoagulation: what are the options?. Crit Care Nurse, 2016, 36(2): 34-41.
26.	张仲华, 金凤兰, 鄢建军. 高危出血倾向患者无肝素连续性肾脏替代治疗体外循环凝血危险因素的研究进展. 中国实用护理杂志, 2014, 30(23): 69-72.
27.	Sagedal S, Hartmann A, Osnes Kr, et al. Intermittent saline flushes during haemodialysis do not alleviate coagulation and clot formation in stable patients receiving reduced doses of dalteparin. Nephrol Dial Transplant, 2006, 21(2): 444-449.
28.	Krummel T, Cellot E, Thiery A, et al. Hemodialysis without anticoagulation: less clotting in conventional hemodialysis than in predilution hemodiafiltration. Hemodial Int, 2019, 23(4): 426-432.
29.	Ramesh Prasad GV, Palevsky PM, Burr R, et al. Factors affecting system clotting in continuous renal replacement therapy: results of a randomized, controlled trial. Clin Nephrol, 2000, 53(1): 55‐60.
30.	梅本刚, 杨燕, 方秀花. 不同冲管方法在连续性肾脏替代治疗中的效果分析. 护士进修杂志, 2018, 33(12): 1150-1151.
31.	王丽君, 沈雪云, 褚志强, 等. 生理盐水冲管频率对无肝素 CRRT 治疗患者血流感染的影响分析. 中华医院感染学杂志, 2018, 28(1): 58-61.

1. Legrand M, Tolwani A. Anticoagulation strategies in continuous renal replacement therapy. Semin Dial, 2021, 34(6): 416-422.
2. Brandenburger T, Dimski T, Slowinski T, et al. Renal replacement therapy and anticoagulation. Best Pract Res Clin Anaesthesiol, 2017, 31(3): 387-401.
3. Nagarik AP, Soni SS, Adikey GK, et al. Comparative study of anticoagulation versus saline flushes in continuous renal replacement therapy. Saudi J Kidney Dis Transpl, 2010, 21(3): 478-483.
4. Karkar A, Ronco C. Prescription of CRRT: a pathway to optimize therapy. Ann Intensive Care, 2020, 10(1): 32.
5. Zhang W, Bai M, Yu Y, et al. Continuous renal replacement therapy without anticoagulation in critically ill patients at high risk of bleeding: a systematic review and meta-analysis. Semin Dial, 2021, 34(3): 196-208.
6. Tsujimoto Y, Miki S, Shimada H, et al. Non-pharmacological interventions for preventing clotting of extracorporeal circuits during continuous renal replacement therapy. Cochrane Database Syst Rev, 2021, 9(9): CD013330.
7. Macedo E, Mehta RL. Continuous dialysis therapies: core curriculum 2016. Am J Kidney Dis, 2016, 68(4): 645-657.
8. Zimbudzi E. Intermittent saline flushes or continuous saline infusion: what works better when heparin-free dialysis is recommended?. Int J Nephrol Renovasc Dis, 2013, 6: 65-69.
9. Lim EK, Seow YT, Chen SE, et al. Simple citrate anticoagulation protocol for low flux haemodialysis. BMC Nephrol, 2018, 19(1): 16.
10. Sanz M, Hidalgo F, García-Fernández N. Circuit life span of continuous renal replacement therapy in critically ill patients with or without conventional anticoagulation: an observational prospective study. An Sist Sanit Navar, 2017, 40(1): 77-84.
11. Szymczak A, Kanafa M, Chuć M, et al. Heparin-free hemodialysis. Postepy Hig Med Dosw, 2018, 72: 671-677.
12. Panphanpho S, Naowapanich S, Ratanarat R. Use of saline flush to prevent filter clotting in continuous renal replacement therapy without anticoagulant. J Med Assoc Thai, 2011, 94 (Suppl 1): S105-S110.
13. Acar E, Cicek HS. The effect of different intermittent intervals of flushing extracorporeal circuits to dialysis adequacy and vital signs in heparin free hemodialysis. Int J Caring Sci, 2018, 11(1): 196-202.
14. Davies H, Leslie G. Maintaining the CRRT circuit: non-anticoagulant alternatives. Aust Crit Care, 2006, 19(4): 133-138.
15. 郭宏晶, 李莉, 向晶, 等. 日间无抗凝 CRRT 患者体外循环管路冲洗护理的研究. 中国血液净化, 2017, 16(9): 635-642.
16. 陈香美. 血液净化标准操作规程. 北京: 人民卫生出版社, 2021.
17. Guéry B, Alberti C, Servais A, et al. Hemodialysis without systemic anticoagulation: a prospective randomized trial to evaluate 3 strategies in patients at risk of bleeding. PLoS One, 2014, 9(5): e97187.
18. 张仲华, 曾铁英, 黄博伦, 等. 无抗凝连续性肾脏替代治疗体外循环装置使用时间影响因素的研究. 护理学杂志, 2019, 34(13): 22-27.
19. Brain M, Winson E, Roodenburg O, et al. Non anti-coagulant factors associated with filter life in continuous renal replacement therapy (CRRT): a systematic review and meta-analysis. BMC Nephrol, 2017, 18(1): 69.
20. 向泳燕, 郭锦丽, 张颖惠, 等. CRRT 体外循环寿命非抗凝危险因素的 Meta 分析. 护理研究, 2023, 37(1): 160-165.
21. 黄显莉, 张胜, 林丽, 等. 盐水冲洗对连续性肾脏替代治疗体外循环寿命及溶质清除的影响. 华西医学, 2022, 37(9): 1314-1321.
22. 中华医学会肾脏病学分会专家组. 连续性肾脏替代治疗的抗凝管理指南. 中华肾脏病杂志, 2022, 38(11): 1016-1024.
23. 黄卓凡, 陈巧玲, 陈钗英, 等. 不同冲洗方式在无抗凝连续性肾脏替代治疗中的效果分析. 全科护理, 2021, 19(3): 354-358.
24. 阮宏兵. 无肝素抗凝连续肾脏替代治疗中滤器冲洗的研究. 济南: 山东大学, 2015.
25. Dirkes S, Wonnacott R. Continuous renal replacement therapy and anticoagulation: what are the options?. Crit Care Nurse, 2016, 36(2): 34-41.
26. 张仲华, 金凤兰, 鄢建军. 高危出血倾向患者无肝素连续性肾脏替代治疗体外循环凝血危险因素的研究进展. 中国实用护理杂志, 2014, 30(23): 69-72.
27. Sagedal S, Hartmann A, Osnes Kr, et al. Intermittent saline flushes during haemodialysis do not alleviate coagulation and clot formation in stable patients receiving reduced doses of dalteparin. Nephrol Dial Transplant, 2006, 21(2): 444-449.
28. Krummel T, Cellot E, Thiery A, et al. Hemodialysis without anticoagulation: less clotting in conventional hemodialysis than in predilution hemodiafiltration. Hemodial Int, 2019, 23(4): 426-432.
29. Ramesh Prasad GV, Palevsky PM, Burr R, et al. Factors affecting system clotting in continuous renal replacement therapy: results of a randomized, controlled trial. Clin Nephrol, 2000, 53(1): 55‐60.
30. 梅本刚, 杨燕, 方秀花. 不同冲管方法在连续性肾脏替代治疗中的效果分析. 护士进修杂志, 2018, 33(12): 1150-1151.
31. 王丽君, 沈雪云, 褚志强, 等. 生理盐水冲管频率对无肝素 CRRT 治疗患者血流感染的影响分析. 中华医院感染学杂志, 2018, 28(1): 58-61.

West China Medical Journal

Research progress on saline flushing extracorporeal circulation line during continuous renal replacement therapy without anticoagulation

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