Zimbudzi Edward
Department of Nephrology, Monash Health, Monash Medical Centre, Clayton, Melbourne, VIC, Australia.
Int J Nephrol Renovasc Dis. 2013 Apr 15;6:65-9. doi: 10.2147/IJNRD.S43252. Print 2013.
Coagulation-free dialysis, also commonly known as "heparin-free" dialysis, can be a challenging procedure as it increases the risk of clotting the dialysis circuit. Utilizing a better saline flushing technique can lead to improved patient outcomes as well as huge financial benefits to the health institution. The purpose of this study was to compare the effectiveness of continuous saline infusion (CSI) and intermittent saline flushing (ISF) in preventing clotting of the dialysis extracorporeal circuit (ECC).
Fifty heparin-free treatments were randomized into two treatment arms, namely CSI and ISF. Predialysis full blood count and coagulation studies were performed for all patients. During ISF, 100 mL saline was infused via the arterial line every 30 minutes while occluding the blood inlet line. Normal saline was infused into the ECC at a rate of 200 mL/hour throughout the duration of dialysis under CSI. The ECC was inspected for clotting and graded accordingly post-dialysis.
Seventy-six percent of the CSI treatments were completed without losing the ECC while 52% of the ISF treatments were also successful. Patients who were treated with CSI were less likely to have clotted ECCs (odds ratio 3.4, 95% CI, 1.04 to 11.2; P = 0.04). No significant differences existed between the two groups' hematological factors that could influence clotting, such as hemoglobin and platelets.
This study demonstrates that, when heparin-free dialysis is indicated, CSI might be a better method of preventing the ECC from clotting. There is a greater chance of realizing long-term benefits to patients and the health service with the CSI method since there is a likelihood of a reduction in the use of erythropoietin-stimulating agents and blood transfusions with the CSI method.
无凝血透析，通常也被称为“无肝素”透析，是一个具有挑战性的过程，因为它会增加透析回路凝血的风险。采用更好的生理盐水冲洗技术可以改善患者预后，并为医疗机构带来巨大的经济效益。本研究的目的是比较持续生理盐水输注（CSI）和间歇性生理盐水冲洗（ISF）在预防透析体外循环（ECC）凝血方面的效果。
将50次无肝素治疗随机分为两个治疗组，即CSI组和ISF组。对所有患者进行透析前全血细胞计数和凝血研究。在ISF期间，每隔30分钟通过动脉管路输注100 mL生理盐水，同时阻断血液入口管路。在CSI期间，在整个透析过程中以200 mL/小时的速度将生理盐水输注到ECC中。透析后检查ECC是否凝血并进行相应分级。
76%的CSI治疗在未丢失ECC的情况下完成，而52%的ISF治疗也取得成功。接受CSI治疗的患者ECC发生凝血的可能性较小（优势比3.4，95%置信区间，1.04至11.2；P = 0.04）。两组之间可能影响凝血的血液学因素，如血红蛋白和血小板，没有显著差异。
本研究表明，当需要进行无肝素透析时，CSI可能是预防ECC凝血的更好方法。由于CSI方法有可能减少促红细胞生成素刺激剂的使用和输血，因此使用CSI方法更有可能为患者和医疗服务带来长期益处。
