Reliability of monitoring acid-base and electrolyte parameters through circuit lines during regional citrate anticoagulation-continuous renal replacement therapy.
Fang Wang, Mingjin Dai, Yuliang Zhao and 5 others
PMID 34382281WHAT IT FOUND
Monitoring acid-base and electrolytes through the CRRT circuit line is reliable when the catheter is connected normally.
However, if the connection is reversed, circuit samples falsely report low ionized calcium. Do not use circuit lines for calcium checks in reversed connections.
Key findings
01In regular connections, no significant differences were found between CVC and circuit line samples for any acid-base or electrolyte parameter.
02In reversed connections, ionized calcium levels in the circuit line were significantly lower than in the CVC line at all measured time points.
03Sampling from the circuit line during a reversed connection is inaccurate for monitoring systemic ionized calcium.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study was conducted at a single center with a small sample size. It only included patients with femoral vein access. The actual access recirculation rate was not measured, so the direct relationship between recirculation and calcium error could not be quantified.
Declared interests
No conflicts of interest were declared in the provided text.
The easy way to misread this
Do not assume that circuit-line sampling is always reliable during CRRT. While it works for regular connections, reversed connections yield falsely low ionized calcium readings from the circuit. Acting on these circuit-line results in reversed connections could lead to incorrect calcium supplementation.