{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,14]],"date-time":"2025-05-14T01:45:49Z","timestamp":1747187149602,"version":"3.40.5"},"reference-count":25,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2021,8,11]],"date-time":"2021-08-11T00:00:00Z","timestamp":1628640000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Nursing in Critical Care"],"published-print":{"date-parts":[[2022,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The current practice involves blood sampling from the circuit line to measure acid\u2010base and electrolyte parameters during continuous renal replacement therapy (CRRT). However, there is limited evidence supporting its reliability due to the effects of anticoagulant mechanism and access recirculation associated with regional citrate anticoagulation (RCA).<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>To evaluate the reliability of monitoring acid\u2010base and electrolyte parameters through circuit lines in regular and reversed connections during RCA\u2010CRRT.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study design<\/jats:title><jats:p>In this prospective cohort study, we included critically ill patients receiving RCA\u2010CRRT via a double\u2010lumen catheter. During the second hour after CRRT initiation, we collected blood samples to monitor acid\u2010base and electrolyte parameters and their levels were compared between samples from the circuit lines (at 0, 3, and 5\u00a0minutes) and those from the central venous catheter (CVC) line (at 0\u00a0minute). During this time, CRRT switched to the replacement state as controls.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We observed 128 CRRT circuits in 60 adult patients receiving RCA\u2010CRRT. Ninety\u2010eight (76.6%) circuits had regular connections, while 30 (23.4%) had reversed connections. Among regular connections, no differences were observed in any acid\u2010base or electrolyte parameters between samples from the CVC line and those from the circuit line at all time points (<jats:italic>P<\/jats:italic>\u00a0&gt;\u2009.05). Among reversed connections, ionized calcium levels were dramatically decreased at all three time points in samples from the circuit line compared with those from the CVC line (0.65\u2009\u00b1\u20090.12, 0.72\u2009\u00b1\u20090.11, and 0.78\u2009\u00b1\u20090.99 vs 0.98\u2009\u00b1\u20090.07\u2009mmol\/L, <jats:italic>P<\/jats:italic>\u00a0&lt;\u2009.001), with comparable levels of other acid\u2010base or electrolyte parameters between the sampling patterns (<jats:italic>P<\/jats:italic>\u00a0&gt;\u2009.05).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Acid\u2010base and electrolyte parameters could be reliably monitored through the circuit line during RCA\u2010CRRT in regular connections. However, in reversed connections, pre\u2010filter ionized calcium concentrations determined through the circuit line were lower than those determined through the CVC line.<\/jats:p><\/jats:sec><jats:sec><jats:title>Relevance to clinical practice<\/jats:title><jats:p>We suggest sampling from arterial or CVC lines rather than from the circuit line in a reversed connection during RCA\u2010CRRT.<\/jats:p><\/jats:sec>","DOI":"10.1111\/nicc.12696","type":"journal-article","created":{"date-parts":[[2021,8,12]],"date-time":"2021-08-12T05:19:59Z","timestamp":1628745599000},"page":"646-651","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Reliability of monitoring acid\u2010base and electrolyte parameters through circuit lines during regional citrate anticoagulation<scp>\u2010<\/scp>continuous renal replacement therapy"],"prefix":"10.1111","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4504-0271","authenticated-orcid":false,"given":"Fang","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Nephrology, West China Hospital, Sichuan University\/West China School of Nursing Sichuan University  Chengdu Sichuan China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mingjin","family":"Dai","sequence":"additional","affiliation":[{"name":"Department of Nephrology, West China Hospital, Sichuan University\/West China School of Nursing Sichuan University  Chengdu Sichuan China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuliang","family":"Zhao","sequence":"additional","affiliation":[{"name":"Deparment of Nephrology, West China Hospital Sichuan University  Chengdu Sichuan China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yingying","family":"Yang","sequence":"additional","affiliation":[{"name":"Deparment of Nephrology, West China Hospital Sichuan University  Chengdu Sichuan China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhiwen","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Nephrology, West China Hospital, Sichuan University\/West China School of Nursing Sichuan University  Chengdu Sichuan China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Li","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Nephrology, West China Hospital, Sichuan University\/West China School of Nursing Sichuan University  Chengdu Sichuan China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xue","family":"Tang","sequence":"additional","affiliation":[{"name":"Department of Nephrology, West China Hospital, Sichuan University\/West China School of Nursing Sichuan University  Chengdu Sichuan China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ling","family":"Zhang","sequence":"additional","affiliation":[{"name":"Deparment of Nephrology, West China Hospital Sichuan University  Chengdu Sichuan China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2021,8,11]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13054-015-0850-8"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13054-015-0822-z"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13054-014-0472-6"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2020.18618"},{"key":"e_1_2_10_6_1","first-page":"1","article-title":"KDIGO clinical practice guideline for acute kidney injury","volume":"2","author":"KDIGO. 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