Name of the Procedure:

Citrate Anticoagulation Dialysis

Summary

Citrate Anticoagulation Dialysis is a procedure used to prevent blood from clotting during dialysis. Citrate, a form of citric acid, is used as an anticoagulant to ensure smooth blood flow through the dialysis machine.

Purpose

Citrate Anticoagulation Dialysis is used to manage patients who need dialysis but have contraindications to heparin (another anticoagulant) or are at high risk of bleeding. The main goal is to perform dialysis effectively while minimizing clotting and bleeding risks.

Indications

• Patients with acute kidney injury or chronic kidney disease requiring dialysis.
• Individuals with a high risk of bleeding or those unable to take heparin.
• Situations where heparin-induced thrombocytopenia (HIT) is a concern.

Preparation

• The patient may need to fast for a few hours before the procedure.
• Current medications, especially anticoagulants or antiplatelets, might need adjustment or discontinuation.
• Diagnostic tests such as blood clotting profiles and electrolyte levels are typically conducted beforehand.

Procedure Description

1. The patient is connected to the dialysis machine.
2. Blood is drawn from the patient's body and passes through the dialysis circuit.
3. As the blood enters the dialysis circuit, citrate is infused to prevent clotting.
4. The blood passes through the dialyzer, where it is filtered and cleaned.
5. Before the filtered blood is returned to the body, calcium is often infused to counteract the calcium-binding effects of citrate, thus restoring normal calcium levels.
6. The procedure continues until the dialysis session is complete, typically several hours.

Duration

The procedure generally takes 3-4 hours per dialysis session.

Setting

The procedure is performed in a hospital dialysis unit, outpatient dialysis center, or specialized nephrology clinic.

Personnel

• Nephrologist (kidney specialist)
• Dialysis nurse
• Dialysis technician
• Anesthesiologist (if sedation is needed)

Risks and Complications

• Hypocalcemia (low calcium levels)
• Metabolic alkalosis (disturbance in the body's acid-base balance)
• Risk of bleeding if citrate levels are too high
• Citrate toxicity
• Catheter-related infections

Benefits

• Effective dialysis with reduced risk of clotting.
• Safer for patients with bleeding disorders or HIT.
• Better patient outcomes in terms of lowered bleeding risks.

Recovery

• Patients can usually return to their normal activities within a few hours after dialysis.
• Instructions may include monitoring for signs of hypocalcemia or electrolyte imbalances.
• Follow-up appointments to monitor kidney function and overall health.

Alternatives

• Heparin-based anticoagulation dialysis
  • Pros: Established method, widely used.
  • Cons: Not suitable for patients at high risk of bleeding or with HIT.
• Dialysis without anticoagulation
  • Pros: No use of anticoagulants.
  • Cons: Higher risk of clotting in the dialysis circuit.

Patient Experience

During the procedure, patients might feel some discomfort associated with needle insertion. However, the majority of the session is typically painless. After the procedure, patients may feel tired and are encouraged to rest. Pain management and comfort measures include the use of local anesthesia for needle insertion and warm blankets during the dialysis session.