[Continuous arteriovenous hemofiltration (CAVH)].

The continuous arteriovenous haemofiltration (CAVH) is a simple, safe, inexpensive and personnel-saving method for treatment of uremic patients. Since the introduction of the CAVH in 1977, far more than 200 patients have been treated by this method in our hospital. In the present paper the method and our experiences during the clinical application are presented. The haemofilter is placed in an extracorporal shunt between the A. and V. femoralis. Cannulation of these vessels is performed by means of a modified Seldinger technique using commercially available catheter. During haemofiltration, heparin is infused into the arterial blood line at a rate of 10 IU/kg . h. The filtrate is totally or partially replaced by nutrition solutions, enteral or parenteral, and by a potassium-free Ringer's lactate i.v. solution, according to the required fluid balance. In most cases the filtrate-substitution rate will be high enough to compensate renal failure, and thus conventional dialysis methods will not be necessary. Clinical experience to date allows the following conclusions: optimal control of water and electrolyte balance; unlimited parenteral nutrition, continuous fluid withdrawal better tolerated than intermittent withdrawal by means of dialysis; low risk of local bleeding with skilled puncture technique of the femoral vessels. Low dose continuous heparin administration into arterial blood line is sufficient for extracorporal anticoagulation. Saving of expenses: No investment costs for machines; specially trained dialysis personnel superfluous.