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Chapter 7: Functional description
7.3.3
Solutions for citrate anticoagulation
Preparation
Treatment
Ci-Ca solutions
7-28
Isotonic NaCl solutions are used for priming the blood and filtrate line
systems of the Ci-Ca cassette. The citrate and calcium lines are filled
with the appropriate citrate and calcium solutions.
Note
The solutions used for the treatment must be selected such that they
match each other. Otherwise, there is a risk of a severe electrolyte
imbalance. In addition, it must be ensured that the flow ratios of the
solutions in relation to each other and to the blood flow match.
Note
The concentration of the citrate solution, the calcium solution used, and
the calcium-containing substitution fluid must be set correctly in the
System parameters / Select Ci-Ca data menu.
Depending on the citrate and calcium solutions used locally, the
concentration of the citrate and calcium ions must be stored in mmol/l
in the System parameters menu of the multiFiltrate. This is done by
technical service personnel. This also applies to the filling volume of the
storage containers used.
The stored concentrations and volumes can be viewed in the Ci-Ca bag
change menu. These values must be confirmed on selection of citrate
anticoagulation and whenever the Change bag menu is used.
For Ci-Ca CVVHD and Ci-Ca postCVVHDF, the sole approved citrate
solution is 4% Na
citrate in each case, containing 136 mmol/l of citrate
3
ions.
The concentration of the calcium solution used may be within a range
from 50 to 500 mmol/l in principle.
The recommended calcium solution is one with approx. 100 mmol/l.
Higher calcium concentrations lead to lower calcium flows and can
increase the risk of local clot formation due to the poorer quality of
intermixing that occurs at the calcium infusion site.
The citrate and calcium solutions must be suitable for infusion.
Note
Despite citrate anticoagulation, local coagulation and clot formation can
occur in the tubing system during the treatment. Perform regular visual
checks of the tubing system, especially in the area from the venous
chamber to the connection to the return line and vascular access. If
visual checks identify clot formation ("white bands") in the direction of
flow, replace the treatment set downstream of the venous chamber,
e.g., at the site where the calcium line discharges into the return line.
Fresenius Medical Care multiFiltrate IFU-EN-UK 15A-2015
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