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.
Objective To investigate the effect of different dilution methods of replacement fluid on cardiopulmonary bypass lifespan and small molecule clearance rate in continuous renal replacement therapy (CRRT) without anticoagulation. Methods Patients who needed to undergo CRRT in West China Hospital of Sichuan University between December 2019 and June 2020 were selected in this prospective cohort study. Continuous veno-venous hemodiafiltration treatment mode was applied, with three different dilution methods, namely pre-dilution, post-dilution, and pre- and post-dilution. The lifespan of cardiopulmonary bypass was recorded, and blood samples were taken to detect creatinine, blood urea nitrogen, etc. Only the lifespan of the first tube of each patient was included. Results A total of 74 patients and pipelines were included, including 18 pre-dilution cases, 34 pre- and post-dilution cases, and 22 post-dilution cases. There was no significant difference in the baseline gender, age, catheterization method, or coagulation function among the three groups of patients (P>0.05). The service life of the circulation pipeline was (32.67±17.42) h in the pre-dilution group and (30.32±16.77) h in the post-dilution group, respectively, and the difference was not statistically significant (P<0.05); the service life of the circulation pipeline was (44.15±21.48) h in the pre- and post-dilution group, which was statistically different from those in the other two groups (P<0.05). There was no statistically significant difference in the decrease of blood urea nitrogen or serum creatinine among the three groups when treated with the three different dilution methods (P>0.05). Conclusion On the premise of not affecting the clearance rate of small molecules, compared with pre-dilution and post-dilution, pre- and post-dilution can prolong the service life of extracorporeal circulation pipelines and filters, and has certain promotion value in clinical practice.
With the development of medical information technology, smart teaching has been widely applied in various fields of medical education. The application of smart teaching technologies such as virtual simulation, intelligent evaluation, and smart teaching platform in blood purification specialized nursing teaching have gradually increased. This article provides an overview of the application of smart teaching mode in blood purification specialized nursing teaching both domestically and internationally, and introduces the integration of online and offline smart teaching mode, in order to provide a theoretical basis for improving the quality of blood purification specialized nursing teaching.
Objective To investigate the safety and efficacy of two different anticoagulation regimens of fondaparinux and low molecular weight heparin (LMWH) in continuous renal replacement therapy (CRRT). Methods The clinical data of patients undergoing CRRT in West China Hospital of Sichuan University between October 2021 and April 2022 were retrospectively analyzed. The patients were divided into fondaparinux sodium group and LMWH group according to anticoagulation with fondaparinux or LMWH during CRRT. The general condition, life expectancy of cardiopulmonary bypass, coagulation events, bleeding events, hemoglobin, and coagulation function-related indicators were compared between the two groups. Results A total of 78 patients were finally included, including 38 in the LMWH group and 40 in the fondaparinux group. The age of the patients in the LMWH group was older than that in the fondaparinux group [76.0 (57.0, 85.0) vs. 63.0 (52.3, 76.0) years, P=0.016]. There was no significant difference in other clinical baseline conditions (including gender, vascular access site, and treatment indications) between the two groups (P≥0.05). The cardiopulmonary bypass life of patients in the fondaparinux group was better than that in the LMWH group [67.1 (35.0, 72.0) vs. 42.0 (20.0, 55.3) h, P=0.003]. The survival rate of cardiopulmonary bypass in the fondaparinux group at 24, 48, and 72 h were higher than that in the LMWH group (87.5% vs. 65.8%, P=0.023; 67.5% vs. 36.8%, P=0.007; 42.5% vs. 13.2%, P=0.004). The incidence of blood filter coagulation events in the fondaparinux group was lower than that in the LMWH group (50.0% vs. 84.2%, P=0.001). There was no significant difference in the incidence of coagulation events and mild bleeding events between the two groups (P>0.05). There was no significant difference in hemoglobin and coagulation function-related indicators between the two groups before and after CRRT (P>0.05). Conclusion The continuity of maintenance therapy with fondaparinux is better than that of LMWH, and the safety of both in the course of CRRT treatment is comparable.