NJCC_01 bwerk v1.indd

The necessity of anticoagulating the extracorporeal circuit (ECC) when applying continuous venovenous haemofiltration (CVVH) in critically ill patients, implicates an increased risk of bleeding complications when using unfractionated heparin or low molecular weight heparins, especially in patients at high risk of bleeding. Regional anticoagulation of the ECC using citratebased solutions has emerged as the most suitable method to avoid this increased risk of bleeding. There are several protocols described in the literature on how to apply this method. The most frequently used method, also in the Netherlands, makes use of a hypertonic trisodium citrate solution, infused prior to the haemofilter, combined with a postdilution replacement fluid. In this article we focus on an alternative method for citrate-based CVVH, using a citrate-containing predilution replacement fluid, combined with calcium-supplementation given separately from the ECC. Potential advantages and limitations of this method are