Nursing interventions in continuous extra-renal depuration techniques with citrate in an Intensive Care Unit

Section: Originals

How to quote

Blanch-Mercader G, Guirao-Mayoral A, Castro-Rebollo P. Intervenciones enfermeras en las técnicas de depuración extrarrenal continuas con citrato en una unidad de cuidados intensivos. Metas Enferm abr 2021; 24(3):7-14. Doi: https://doi.org/10.35667/MetasEnf.2021. 24.1003081729

Authors

Gemma Blanch-Mercader1, Ana Guirao-Mayoral2, Pedro Castro-Rebollo3

Position

1Máster en la atención al paciente con enfermedad cardiovascular. Área de Vigilancia Intensiva. Hospital Clínic de Barcelona. Barcelona2Máster en Enfermo Crítico y Emergencias. Área de Vigilancia Intensiva. Hospital Clínic de Barcelona. Barcelona3Doctor en medicina y cirugía. Área de Vigilancia Intensiva. Hospital Clínic de Barcelona. IDIBAPS. Universitat de Barcelona. Barcelona

Contact address

Ana Guirao Mayoral. C/ Amílcar, 1-3. 08031 Barcelona

Contact email: anaguiraomayoral@gmail.com

Abstract

Objective: to describe the use of filters in continuous venovenous hemodiafiltration therapy (CVVHDF) during the first year of use of citrate as anticoagulant in the Intensive Care Unit (ICU) of the Hospital Clínic of Barcelona, as well as nursing interventions and generation of alarms associated to this therapy.
Method: a cross-sectional descriptive study was conducted on a series of cases (December, 2016 to December, 2017), with a longitudinal component for the analysis of nursing interventions and alarms. The study included >18-year-old patients hospitalized in Intensive Care who required CVVHDF with citrate. Through clinical records and direct observation, there was a collection of patient and therapy-related variables, as well as of the alarms and the interventions associated. Descriptive statistics indexes were conducted, as well as bivariate analysis.
Results: seventeen (17) patients were included, using 38 filters in total. The median time of CVVHDF duration was five days, and 52 hours for each filter. The most common reason for change of filter was coagulation (34%). In total, 2.9 nursing interventions were conducted per hour (70% were specific for the therapy). A decreasing tendency was observed, not statistically significant, for interventions and alarms during the first three days.
Conclusion: anticoagulation with citrate in CVVHDF was associated with frequent nursing interventions, as well as with an increase in the half-life of the filter. Taking also into account the reduction in risk of hemorrhage, the benefits of the treatment overall seem to overcome its drawbacks from the point of view of nursing interventions.

Keywords:

Citrate; continuous extra-renal depuration techniques; anticoagulation; Intensive Care Units; series of cases

Versión en Español

Título:

Intervenciones enfermeras en las técnicas de depuración extrarrenal continuas con citrato en una unidad de cuidados intensivos