haemofiltration and APTT, can i ask......

[dissle]

We are about to start training on Prisma flex by Gambro.

These machines do not have a needle free system for sampling blood for APTT, we have to use a needle and syringe. This is a practice that we are desperate to avoid/stop using.

We could sample from the A-Line, however there is a marked difference between the results given from a sample taken from an A-Line and that of a circiut sample.

We are interested in heparinisation of the circuit and not the patient.

How do you do this in your depts?

I am a bit stuck with this problem, and i am very interested in how the rest of the world do this.

Many thanks,

Dissle x

[moonshadeau, ADN, BSN, MSN, RN, APN, NP, CNS]

We anticoagulate the circut with citrate and use calcium chloride to bind the citrate prior to re-entry into the patient. We very rarely use heparin to anticoagulate the patient or the circut.

[blackpool]

Hiya,

I am having exactly the same problem. We are introducing the prismalex too. We currently use the Prisma and take an ACT using a needle from the post filter port. We want to get out of this because of obvious infection control issues and risk of needlestck injuries etc. We anticoagulate mainly with heparin, or flolan if the patient has low platelets. It is going to create an awful lot of work to change our procedures, guidelines etc. Is Aptt the best option, if so where from - the arterial line? Has anyone got any experience of this? I would really appreciate your help

[suetje]

You can do an APTT from the a-line. You are really watching to see if he is SYSTEMICALLY anticoagulated. So, even though you are only wanting to heparinize the tubing circuit itself, you still are anticoagulating the patient. Citrate is the best option, but it does (as mentioned abve) require a calcium continuous infusion to bind up the citrate, more labs to monitor the calcium too.

[dorimar, BSN, RN]

I was used to ensuring anticoagulation with citrate, instead of heparin. Not sure for the prisma though. I will see my friend in the am who works primarily with that system and get her input.

[ghillbert, MSN, NP]

Can you put a stopcock in the line just before it goes back to the patient and sample from there? That gives a good indication of the circuit anticoagulation.

I don't know that I agree that an arterial sample will do, or that you're checking for systemic a/c - in my experience, we were checking to see how anticoagulated the circuit was so that it didn't clot off. Systemic a/c was checked with routine pt labs.