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

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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

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, Chu? 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. 日間無抗凝 CRRT 患者體外循環管路沖洗護理的研究. 中國血液凈化, 2017, 16(9): 635-642.
16.	陳香美. 血液凈化標準操作規程. 北京: 人民衛生出版社, 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.	張仲華, 曾鐵英, 黃博倫, 等. 無抗凝連續性腎臟替代治療體外循環裝置使用時間影響因素的研究. 護理學雜志, 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, 郭錦麗, 張穎惠, 等. CRRT 體外循環壽命非抗凝危險因素的 Meta 分析. 護理研究, 2023, 37(1): 160-165.
21.	黃顯莉, 張勝, 林麗, 等. 鹽水沖洗對連續性腎臟替代治療體外循環壽命及溶質清除的影響. 華西醫學, 2022, 37(9): 1314-1321.
22.	中華醫學會腎臟病學分會專家組. 連續性腎臟替代治療的抗凝管理指南. 中華腎臟病雜志, 2022, 38(11): 1016-1024.
23.	黃卓凡, 陳巧玲, 陳釵英, 等. 不同沖洗方式在無抗凝連續性腎臟替代治療中的效果分析. 全科護理, 2021, 19(3): 354-358.
24.	阮宏兵. 無肝素抗凝連續腎臟替代治療中濾器沖洗的研究. 濟南: 山東大學, 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.	張仲華, 金鳳蘭, 鄢建軍. 高危出血傾向患者無肝素連續性腎臟替代治療體外循環凝血危險因素的研究進展. 中國實用護理雜志, 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.	梅本剛, 楊燕, 方秀花. 不同沖管方法在連續性腎臟替代治療中的效果分析. 護士進修雜志, 2018, 33(12): 1150-1151.
31.	王麗君, 沈雪云, 褚志強, 等. 生理鹽水沖管頻率對無肝素 CRRT 治療患者血流感染的影響分析. 中華醫院感染學雜志, 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, Chu? 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. 日間無抗凝 CRRT 患者體外循環管路沖洗護理的研究. 中國血液凈化, 2017, 16(9): 635-642.
16. 陳香美. 血液凈化標準操作規程. 北京: 人民衛生出版社, 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. 張仲華, 曾鐵英, 黃博倫, 等. 無抗凝連續性腎臟替代治療體外循環裝置使用時間影響因素的研究. 護理學雜志, 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, 郭錦麗, 張穎惠, 等. CRRT 體外循環壽命非抗凝危險因素的 Meta 分析. 護理研究, 2023, 37(1): 160-165.
21. 黃顯莉, 張勝, 林麗, 等. 鹽水沖洗對連續性腎臟替代治療體外循環壽命及溶質清除的影響. 華西醫學, 2022, 37(9): 1314-1321.
22. 中華醫學會腎臟病學分會專家組. 連續性腎臟替代治療的抗凝管理指南. 中華腎臟病雜志, 2022, 38(11): 1016-1024.
23. 黃卓凡, 陳巧玲, 陳釵英, 等. 不同沖洗方式在無抗凝連續性腎臟替代治療中的效果分析. 全科護理, 2021, 19(3): 354-358.
24. 阮宏兵. 無肝素抗凝連續腎臟替代治療中濾器沖洗的研究. 濟南: 山東大學, 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. 張仲華, 金鳳蘭, 鄢建軍. 高危出血傾向患者無肝素連續性腎臟替代治療體外循環凝血危險因素的研究進展. 中國實用護理雜志, 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. 梅本剛, 楊燕, 方秀花. 不同沖管方法在連續性腎臟替代治療中的效果分析. 護士進修雜志, 2018, 33(12): 1150-1151.
31. 王麗君, 沈雪云, 褚志強, 等. 生理鹽水沖管頻率對無肝素 CRRT 治療患者血流感染的影響分析. 中華醫院感染學雜志, 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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