Heparinski protocol-Kraljevina Katar- Allan Moral

A – Before the treatment:

1. Please use Catheter Fr 12 and above (if possible like Fr. 12.5)
2. Add heparin to the NSS priming solution bag (if patient has no contraindication of
Heparin, for example: HIT type 1 or 2). 5000 IU of Heparin (as per the Prismaflex CRRT
Kit IFU)
3. Flush the heparin from circuit with NSS (without Heparin).
4. Check patient’s coagulation profile (either using APTT or ACT) – to know baseline
parameters.
5. Set the continuous Heparin infusion (ml/hr) Both bolus and infusion rate is according to
patient’s Body weight. Continuous infusion rate is between 5 IU – 20 IU/Kg/hr
6. Set Blood Flow Rate only. The rest of fluid flow rates will follow later once the Blood
Flow Rate becomes stabilized (at least 3 – 5 minutes)

B – During CRRT Treatment:

1. After pressing start of CRRT treatment, deliver the Heparin Bolus immediately to get
started the activation of Heparin. It is range between 20 IU – 40 IU/Kg BW.
2. Increase the Blood Flow Rate once the blood has returned back to patient to 150 ml/min
(while checking the patient’s Blood Pressure, Access & Return Pressures).
3. Once pressures are good, increase the Blood Flow Rate to 190 or 200 ml/min (subject to
patient’s hemodynamic tolerance and
4. Set the Fluid Flow Rates according to the prescriptions.
5. 30 min from the Start of Treatment – check the APTT or ACT. (Ensure that APTT or ACT
value is reaching 1.5 to 1.8 times from the Baseline)
6. Usually, the APTT target is between (60 – 80 seconds). Less than 60 seconds, the filter is
high risk of clotting. Higher than 80 seconds, a patient is high risk of bleeding.
7. Repeat APTT check 30 min after – to double check if the result is consistent in achieving
the APTT target.
8. Once the APTT target is achieved, then every 4 hours check/control for 24 hours. Every 6
hours after 24 hours (once stable).

Podešavanje protoka krvi i fluida

The tendency if you set the entire flow rates (combining Blood & fluid flow rates) simultaneously at
the beginning, the filtration fraction becomes extremely high (which can accelerate the clotting). Let
the circuit first filled with blood, then followed by fluids. It’s similar approach to IHD treatment (Artis
& AK98) and other HD monitors.

Kombinacija Heparin-Citrat:
Some Hospitals managing the CRRT mainly for COVID patients are using combination of Heparin (as
patient systemic anticoagulation to manage hypercoagulation) – patient specific indication. And
Regional Citrate Anticoagulation for the Filter/Circuit(to ensure filter longevity).
Heparinski protokol-Kraljevina Katar

A – Pre tretmana:

1. Preferirana širina korišćenog katetera 12 Frenča i više

2. Dodati heparin u prvu kesu za ispiranje (ako pacijent nema kontraindikacije za Heparin,
na primer: HIT tip 1 ili 2). 5000 IU Heparina
3. Drugu kesu za ispiranje koristiti bez Heparina.
4. Proveriti pacijentov koagulacioni profil (koristeći APTT ili ACT) – da bismo znali početne
parametre.
5. Podesite kontinuiranu isporuku Heparina tokom CRRT (ml/hr): i bolus doziranje tokom
tretmana iili kontinuirana brzina isporuke Heparina tokom tretmana se podešava prema
telesnoj težini pacijenta. Doziranje: 5 IU/Kg/hr – 20 IU/Kg/hr
6. Podesiti samo brzinu krvi. Podešavanje brzine isporuke tečnosti će uslediti nakon što se
stabilizuje protok krvi i pacijentovi hemodinamski parametri (minimum 3 – 5 minuta)

B – Tokom CRRT Tretmana:

1. Nakon početka CRRT tretmana, dajte trenutni početni Heparinski Bolus kako bi se
započela aktivacija heparina. Opseg između 20 IU – 40 IU/Kg tel. težine.
2. Povećati brzinu krvi nakon što se krv vratila u pacijenta , na 150 ml/min (opservirajući
parameter pritisaka: Pristupni & Povratni pritisci).
3. Kada su pritisci stabilni, povećati brzinu krvi na 190 do 200 ml/min (zavisno od
mogućnosti katetera i pacijentove hemodinamike)
4. Podestite protoke tečnosti prema preskripciji.
5. 30 min od Poetka tretmana ponovo proveriti –APTT ili ACT. (Pobrinite se da APTT ili ACT
dostigne 1.5 do 1.8 puta veću vrednost od početne, npr: aPTT=60-80s; ACT=180-200s)
6. Proveriti aPTT/ACT još jednom nakon 30 min– da bi ponovo proverili da li je rezultat
konzistentan.
7. Ako rezultat varira: