System and method for delivery of regional citrate anticoagulation to extracorporeal blood circuits

A method for regional citrate anticoagulation in an extracorporeal blood circuit including an arterial blood line arranged to be connected to a vascular access for withdrawing blood from a patient and a venous blood line arranged to be connected to the vascular access for returning blood to the patient, the method comprising:

• providing a hemofilter in fluid communication with the arterial and venous blood lines;
• infusing a first pre-filter infusion solution comprising a citrate anticoagulant-containing solution into blood in the arterial blood line upstream from the hemofilter;
• infusing a second pre-filter infusion solution comprising a first bicarbonate-containing solution into blood in the arterial blood line upstream from the hemofilter;
• infusing a post-filter infusion solution comprising a second bicarbonate-containing solution into blood in the venous blood line downstream from the hemofilter, wherein at least one of the first and second bicarbonate-containing solutions has a bicarbonate concentration of about 20-60 mmol/L;
• infusing an additional infusion solution comprising a calcium- and magnesium-containing solution into blood in the venous blood line downstream from a connection of the post-filter infusion solution;
• and
• monitoring plasma flow online to calculate an infusion rate of the citrate anticoagulant-containing solution and the bicarbonate solutions necessary to keep a single pass fractional extraction of citrate on the hemofilter greater than or equal to 66%.

A system for regional citrate anticoagulation in an extracorporeal blood circuit including an arterial blood line arranged to be connected to a vascular access for withdrawing blood from a patient and a venous blood line arranged to be connected to the vascular access for returning blood to the patient, the system comprising:

• a hemofilter in fluid communication with the arterial and venous blood lines;
• a first pre-filter infusion line connected to the arterial blood line upstream from the hemofilter for infusing a first pre-filter infusion solution comprising a citrate anticoagulant-containing solution into blood in the arterial blood line;
• a second pre-filter infusion line connected to the arterial blood line upstream from the hemofilter for infusing a second pre-filter infusion solution comprising a first bicarbonate-containing solution into blood in the arterial blood line;
• a post-filter infusion line connected to the venous blood line downstream from the hemofilter for infusing a post-filter infusion solution comprising a second bicarbonate-containing solution into blood in the venous blood line;
• an additional infusion line connected to the venous blood line downstream from a connection of the post-filter infusion line for infusing an additional infusion solution comprising a calcium- and magnesium-containing solution into blood in the venous blood line;
• an effluent fluid line in fluid communication with the hemofilter for containing a filter effluent fluid;
• a dextrose sensor operably connected to the effluent fluid line for measuring dextrose concentration in the filter effluent fluid;
• and
• a control program for coordinating and monitoring the operation of the system programmed to use data from the dextrose sensor to indicate citrate removal on the hemofilter.

A method for regional citrate anticoagulation in an extracorporeal blood circuit including an arterial blood line arranged to be connected to a vascular access for withdrawing blood from a patient and a venous blood line arranged to be connected to the vascular access for returning blood to the patient, the method comprising:

• providing a hemofilter in fluid communication with the arterial and venous blood lines;
• infusing a first pre-filter infusion solution comprising a citrate anticoagulant-containing solution into blood in the arterial blood line upstream from the hemofilter;
• infusing a second pre-filter infusion solution comprising a first bicarbonate-containing solution into blood in the arterial blood line upstream from the hemofilter;
• infusing a post-filter infusion solution comprising a second bicarbonate-containing solution into blood in the venous blood line downstream from the hemofilter;
• infusing an additional infusion solution comprising a calcium- and magnesium-containing solution into blood in the venous blood line downstream from a connection of the post-filter infusion solution;
• and
• providing an effluent fluid line in fluid communication with the hemofilter for containing a filter effluent fluid;
• sensing dextrose concentration in the filter effluent fluid;
• and
• coordinating and monitoring the operation of the system by using the dextrose concentration to indicate citrate removal on the hemofilter.