325 Regional Heparinization for Aquadex™ Ultafiltration System in Volume Overloaded Patients Using Heparin and Protamine

Abstract

REGIONAL HEPARINIZATION FOR AQUADEX ULTAFILTRATION SYSTEM IN VOLUME OVERLOADED PATIENTS USING HEPARIN AND PROTAMINE Ruchir Trivedi, Andre A. Kaplan. University of Connecticut Health Center, Farmington, CT 06032 Regional anticoagulation with heparin-protamine or citrate has been successfully employed during CRRT. Citrate use is limited by the patient’s capacity to metabolize citrate, which is decreased if liver function or tissue perfusion is compromised. Citrate accumulation causes metabolic acidosis and resultant hypocalcemia can cause myocardial depression. We have previously described using regional heparinization with protamine during CRRT (Kaplan & Petrillo. Trans ASAIO 33:312, 1987). We now describe 2 patients with successful regional heparinization using the Aquadex ultrafiltration system. This system uses smaller, 6F dual lumen antecubital catheters with blood flows to 40 mL/min and ultrafiltration potential of 10-240 mL/hr. A 65 year old female with advance alcoholic cirrhosis and pulmonary hypertension presented with rapid onset edema, ascites and 25 Kg wt. gain. Low dose diuretic therapy resulted in rapid worsening of azotemia and creatinine. Patient was placed on ultrafiltration using Aquadex system with pre-filter heparinization at 800 IU/hr. and post-filter protamine at 8 mg/hr. Systemic PTT was monitored every 6 hours with operator modification of heparin and protamine dosage to keep systemic PTT 150 sec (166-200). Filter remained patent for 3 days. Renal function remained stable. These cases demonstrate that regional heparinization with protamine reversal in low flow ultrafiltration system is effective and safe with near normal systemic PTT and can be used in patients with cirrhosis where citrate based anticoagulation has significant potential toxicity.