Continuous Arteriovenous Hemofiltration: Improvement in the Handling of Fluid Balance and Heparinization

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Abstract
To overcome the laborsome manual handling of fluid exchange in continuous arteriovenous hemofiltration (CAVH), we developed a simple mechanical system for automatic fluid exchange which consists of a vertical stand having two mechanically coupled horizontal cross-beams. The substitution fluid (4.5-liter bags) hanging at the upper beam is counterbalanced by a weight on the opposite side. When hemofïltrate is dripping from the filter into the container hanging below the substitution fluid at the lower beam, the growing imbalance opens a tube clamp mechanically setting the fluid substitution to the rate of filtration with a degree of accuracy of ± 10 ml/4.5-liter exchange.To effect a negative balance, a 2-liter container on the opposite side (counterweight side) can be filled by a dripping infusion, the rate of which determines the negative balance. This system was used as an aid for CAVH in 50 patients with acute, mainly postoperative renal failure. Continuous heparinization as an other disadvantage in CAVH can be modified with a minimal increase of systemic partial thrombin time, if an adequate mixing with blood before the hemofilter is guaranteed.

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