Continuous Renal Replacement Therapy Without Anticoagulation: Top Ten Tips to Prevent Clotting

Continuous renal replacement therapy (CRRT) is intended to function continuously and is prescribed for this outcome. Anticoagulants may not always be used. Clotting and clogging within the CRRT filter stopping therapy occurs with a variability in the total elapsed time associated. This is commonly known as the circuit or filter “life”. It is very useful and important to record this time at the bedside and refer to this as a measure of success and quality. Filter life (i.e., hours) is reported in many reports investigating CRRT but is not well understood or clear for when this is considered inadequate and clinical review strategies should be considered. Failure before 8 h could be associated with inadequate renal support and “therapy”. Anticoagulation is the key intervention to prolong filter function; however, the extracorporeal circuit design and set up, access catheter profile and insertion site, CRRT machine settings, and the human interface operating CRRT are always important and the only consideration to prevent failure when no anticoagulation is mandated for CRRT.