Haematocrit monitoring and blood volume estimation during continuous renal replacement therapy.

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  • Additional Information
    • Source:
      Publisher: Confederation of Australian Critical Care Nurses Country of Publication: Australia NLM ID: 9207852 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1036-7314 (Print) Linking ISSN: 10367314 NLM ISO Abbreviation: Aust Crit Care Subsets: MEDLINE
    • Publication Information:
      Publication: North Strathfield : Confederation of Australian Critical Care Nurses
      Original Publication: North Strathfield, NSW : The Confederation, [1992-
    • Subject Terms:
      Continuous Renal Replacement Therapy*/methods ; Blood Volume*; Humans ; Hematocrit ; Monitoring, Physiologic/methods ; Blood Volume Determination/methods ; Male ; Acute Kidney Injury/therapy ; Acute Kidney Injury/blood
    • Abstract:
      Background: Continuous haemoglobin, venous blood oxygen saturation, and haematocrit (Hct) monitoring is currently not applied during continuous renal replacement therapy (CRRT). Such Hct monitoring enables estimation of changes in blood volume as percentage change (ΔBV%) from therapy start time and is incorporated into intermittent haemodialysis machines but not CRRT machines despite its potential to optimise fluid management in CRRT patients.
      Methods: To overcome this problem, we used a standalone monitor (CRIT-LINE®IV, Fresenius Medical Care, Concord, USA) with an associated in-line blood chamber (CRIT-LINE®IV Blood Chamber, Fresenius Medical Care, Concord, USA) and designed our own adaptor connection piece (TekMed and Morriset, Melbourne and Brisbane, Australia) to allow these readings at the vascular access outflow and recorded data for estimated Hct and derived ΔBV% during CRRT.
      Results: We report on this technique with an illustrative case example and 12 h of CRRT data on the fluid loss rate prescribed, hourly net patient fluid loss (range: 0-308 mL/h), mean arterial pressure, norepinephrine dose (range: 5-14 mcg/min), estimated continuous Hct and ΔBV%, and the otherwise undetected diagnosis of an approximate 15 % decrease in blood volume during the CRRT.
      Conclusion: We have described a technical CRRT circuit modification that can facilitate a previously unavailable assessment of fluid shifts during CRRT. Further application in clinical trials is now possible.
      (Copyright © 2023 Australian College of Critical Care Nurses Ltd. All rights reserved.)
    • Contributed Indexing:
      Keywords: Acute kidney injury; Fluid balance; Haematocrit; Methods; Net ultrafiltration rate; Relative blood volume
    • Publication Date:
      Date Created: 20240120 Date Completed: 20240613 Latest Revision: 20240613
    • Publication Date:
      20240614
    • Accession Number:
      10.1016/j.aucc.2023.11.005
    • Accession Number:
      38245397