Abstract

BELCHI ROSIQUE, Francisco  and  ALFARO CUENCA, Antonia. Heparin-free haemodialysis. double continuous rinsing system: is it better than the continuous prefilter rinsing system?. Rev Soc Esp Enferm Nefrol [online]. 2006, vol.9, n.2, pp.60-63. ISSN 1139-1375.

When anti-coagulation is contraindicated, alternative methods have to be used. When faced with circuit coagulation problems during the haemodialysis session a “continuous rinsing” system of the equipment may be a valid alternative. The result of the technique can be improved by increasing the dilution of the blood in the vein chamber. Double continuous rinsing is the name given to the technique used. It consists of the continuous and simultaneous administration during the haemodialysis session of physiological saline solution through the arterial chamber, while in the vein chamber we administer physiological saline solution alternated with bicarbonate 1/6 M, to avoid possible acidosis caused by the high volumes of saline solution, at a rate of 1 litre/h through the arterial chamber and 500 ml/h through the vein chamber, using two IVAC infusion pumps with the systems connected directly to these chambers. 50 sessions were carried out with simple rinsing (R1) and 50 with double continuous rinsing (R2). The appearance of clots in the arterial and vein chambers, the change of lines and the need to end the session early due to coagulation of the circuit were all observed. With L2 the arterial chamber remained clean in 80 % of cases, compared to 50% with L1; in the vein chamber, significant clots appeared in 29 sessions and coagulation occurred in 8 sessions with L1, while with L2 coagulation occurred on 4 occasions. With L1 the treatment had to be ended early in 5 sessions, while with L2 this occurred in 2. Coagulation of 50% of the fibres at the end of the session was observed in 60% of cases with L1, while with L2 this was observed in 34%. Double continuous rinsing is an effective nursing technique when there are contraindications to conventional anti-coagulation.

Keywords : heparin-free haemodialysis; continuous prefilter rinsing; double continuous rinsing.

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