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Sample collection /
extracorporeal blood
circuit
Frequency of laboratory
tests
Magnesium
Sodium
Fresenius Medical Care multiFiltrate IFU-EN-UK 15A-2015
Note
In situations presenting an increased risk of recirculation, e.g., reverse
catheter connection or femoral catheter position, the sampling site on
the access line should not be used. Unexpectedly low measurement
values of the systemic ionised calcium for a sample collected at this site
should always be checked by measuring a separately collected
systemic sample.
To check the ionised calcium in the extracorporeal blood circuit, the
blood sample is collected from the sampling site (blue) of the return line
downstream of the filter.
The systemic acid-base status and systemic ionised calcium should be
checked prior to the treatment. If there is no other clinical indication,
hypocalcemia should be corrected before the start of the Ci-Ca
treatment.
The ionised calcium downstream of the filter should be checked approx.
5 minutes after the start of the treatment to verify correct connection.
Note
If no significant reduction of the post-filter ionised calcium is detected
during the first measurement performed 5 minutes after the start of the
treatment, the treatment must be stopped immediately. This may be
indicative of an incorrect connection. It is particularly important to check
that the citrate and calcium solution have not been reversed.
All three laboratory parameters must be regularly checked during the
Ci-Ca treatment. The intervals necessary for these regular
determinations depend on the patient's clinical situation.
Note
Whenever a situation is not clear and is possibly associated with an
abnormal concentration of systemic ionised calcium or with a disturbed
acid-base status, these parameters should be checked immediately.
Since citrate forms a complex not only with calcium but also with
magnesium, there is also a shift of protein-bound magnesium towards
magnesium-citrate complexes which may pass through the membrane
of the filter. Compared with CRRT solutions commonly used for
systemic anticoagulation, the use of a slightly higher magnesium
concentration in the dialysate used or an additional infusion of
magnesium may be indicated.
Hypernatraemia has been reported for some variants of citrate
anticoagulation. This was caused by excessive sodium concentrations
in the citrate solution used, in combination with a failure to adjust the
sodium concentration in the HF solution / dialysate. Therefore, the Na
concentration of Ci-Ca dialysates K2 and Ci-Ca dialysates K4 has been
adjusted to 133 mmol/l.
Chapter 7: Functional description
7-21
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