System and method for delivery of regional citrate anticoagulation to extracorporeal blood circuits
First Claim
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1. A system for regional citrate anticoagulation in an extracorporeal blood circuit including an arterial blood line arranged to be connected to a vascular access for withdrawing blood from a patient and a venous blood line arranged to be connected to the vascular access for returning blood to the patient, the system comprising:
- a hemofilter in fluid communication with the arterial and venous blood lines;
a first pre-filter infusion line connected to the arterial blood line upstream from the hemofilter for infusing a first pre-filter infusion solution comprising a citrate anticoagulant-containing solution into blood in the arterial blood line;
a second pre-filter infusion line connected to the arterial blood line upstream from the hemofilter for infusing a second pre-filter infusion solution comprising a first bicarbonate-containing solution into blood in the arterial blood line;
a post-filter infusion line connected to the venous blood line downstream from the hemofilter for infusing a post-filter infusion solution comprising a second bicarbonate-containing solution into blood in the venous blood line, wherein at least one of the first and second bicarbonate-containing solutions has a bicarbonate concentration of about 20-60 mmol/L;
an additional infusion line connected to the venous blood line downstream from a connection of the post-filter infusion line for infusing an additional infusion solution comprising a calcium- and magnesium-containing solution into blood in the venous blood line; and
a control program for coordinating and monitoring the operation of the system, the control program programmed to monitor plasma flow online to calculate an infusion rate of the citrate anticoagulant-containing solution and the bicarbonate solutions necessary to keep a single pass fractional extraction of citrate on the hemofilter greater than or equal to 66%.
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Abstract
The present invention includes a comprehensive replacement fluid system and method for the delivery of regional citrate anticoagulation (RCA) to extracorporeal blood circuits, wherein the system may include an online clearance monitor (OCM) and a circuit effluent online sensor system (OSS) for the continuous determination of patient plasma content of ultrafilterable solutes.
58 Citations
32 Claims
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1. A system for regional citrate anticoagulation in an extracorporeal blood circuit including an arterial blood line arranged to be connected to a vascular access for withdrawing blood from a patient and a venous blood line arranged to be connected to the vascular access for returning blood to the patient, the system comprising:
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a hemofilter in fluid communication with the arterial and venous blood lines; a first pre-filter infusion line connected to the arterial blood line upstream from the hemofilter for infusing a first pre-filter infusion solution comprising a citrate anticoagulant-containing solution into blood in the arterial blood line; a second pre-filter infusion line connected to the arterial blood line upstream from the hemofilter for infusing a second pre-filter infusion solution comprising a first bicarbonate-containing solution into blood in the arterial blood line; a post-filter infusion line connected to the venous blood line downstream from the hemofilter for infusing a post-filter infusion solution comprising a second bicarbonate-containing solution into blood in the venous blood line, wherein at least one of the first and second bicarbonate-containing solutions has a bicarbonate concentration of about 20-60 mmol/L; an additional infusion line connected to the venous blood line downstream from a connection of the post-filter infusion line for infusing an additional infusion solution comprising a calcium- and magnesium-containing solution into blood in the venous blood line; and a control program for coordinating and monitoring the operation of the system, the control program programmed to monitor plasma flow online to calculate an infusion rate of the citrate anticoagulant-containing solution and the bicarbonate solutions necessary to keep a single pass fractional extraction of citrate on the hemofilter greater than or equal to 66%. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19)
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20. A method for regional citrate anticoagulation in an extracorporeal blood circuit including an arterial blood line arranged to be connected to a vascular access for withdrawing blood from a patient and a venous blood line arranged to be connected to the vascular access for returning blood to the patient, the method comprising:
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providing a hemofilter in fluid communication with the arterial and venous blood lines; infusing a first pre-filter infusion solution comprising a citrate anticoagulant-containing solution into blood in the arterial blood line upstream from the hemofilter; infusing a second pre-filter infusion solution comprising a first bicarbonate-containing solution into blood in the arterial blood line upstream from the hemofilter; infusing a post-filter infusion solution comprising a second bicarbonate-containing solution into blood in the venous blood line downstream from the hemofilter, wherein at least one of the first and second bicarbonate-containing solutions has a bicarbonate concentration of about 20-60 mmol/L; infusing an additional infusion solution comprising a calcium- and magnesium-containing solution into blood in the venous blood line downstream from a connection of the post-filter infusion solution; and monitoring plasma flow online to calculate an infusion rate of the citrate anticoagulant-containing solution and the bicarbonate solutions necessary to keep a single pass fractional extraction of citrate on the hemofilter greater than or equal to 66%. - View Dependent Claims (21, 22, 23, 24, 25, 26, 27, 28, 29, 30)
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31. A system for regional citrate anticoagulation in an extracorporeal blood circuit including an arterial blood line arranged to be connected to a vascular access for withdrawing blood from a patient and a venous blood line arranged to be connected to the vascular access for returning blood to the patient, the system comprising:
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a hemofilter in fluid communication with the arterial and venous blood lines; a first pre-filter infusion line connected to the arterial blood line upstream from the hemofilter for infusing a first pre-filter infusion solution comprising a citrate anticoagulant-containing solution into blood in the arterial blood line; a second pre-filter infusion line connected to the arterial blood line upstream from the hemofilter for infusing a second pre-filter infusion solution comprising a first bicarbonate-containing solution into blood in the arterial blood line; a post-filter infusion line connected to the venous blood line downstream from the hemofilter for infusing a post-filter infusion solution comprising a second bicarbonate-containing solution into blood in the venous blood line; an additional infusion line connected to the venous blood line downstream from a connection of the post-filter infusion line for infusing an additional infusion solution comprising a calcium- and magnesium-containing solution into blood in the venous blood line; an effluent fluid line in fluid communication with the hemofilter for containing a filter effluent fluid; a dextrose sensor operably connected to the effluent fluid line for measuring dextrose concentration in the filter effluent fluid; and a control program for coordinating and monitoring the operation of the system programmed to use data from the dextrose sensor to indicate citrate removal on the hemofilter.
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32. A method for regional citrate anticoagulation in an extracorporeal blood circuit including an arterial blood line arranged to be connected to a vascular access for withdrawing blood from a patient and a venous blood line arranged to be connected to the vascular access for returning blood to the patient, the method comprising:
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providing a hemofilter in fluid communication with the arterial and venous blood lines; infusing a first pre-filter infusion solution comprising a citrate anticoagulant-containing solution into blood in the arterial blood line upstream from the hemofilter; infusing a second pre-filter infusion solution comprising a first bicarbonate-containing solution into blood in the arterial blood line upstream from the hemofilter; infusing a post-filter infusion solution comprising a second bicarbonate-containing solution into blood in the venous blood line downstream from the hemofilter; infusing an additional infusion solution comprising a calcium- and magnesium-containing solution into blood in the venous blood line downstream from a connection of the post-filter infusion solution; and providing an effluent fluid line in fluid communication with the hemofilter for containing a filter effluent fluid; sensing dextrose concentration in the filter effluent fluid; and coordinating and monitoring the operation of the system by using the dextrose concentration to indicate citrate removal on the hemofilter.
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Specification