title: Insertion side, body position and circuit life during continuous renal replacement therapy with femoral vein access.
abstract: BACKGROUND
  Choice of insertion side and patient position during continuous renal replacement therapy (CRRT) with femoral vein vascular access may affect circuit life. We investigated if there is an association between choice of insertion side and body position and its changes and circuit life during CRRT with femoral vein access.
  
  
  METHODS
  We studied 50 patients receiving CRRT via femoral vein access with a sequential retrospective study in a tertiary intensive care unit. We defined two groups: patients with right or left femoral vein access. We then obtained information on age, gender, circuit life, total heparin dose, hemoglobin concentration and coagulation variables (platelet count, international normalized ratio, and activated partial thromboplastin time) and percentage of time each patient spent in the supine, left lying, right lying, and sitting position during treatment.
  
  
  RESULTS
  We studied 341 circuits in 50 patients. Mean circuit life was 13.9 h. Of these circuits, 251 (73.6%) were treated with right femoral vein access. Mean circuit life in this group was significantly longer compared with left femoral vein access (15.0 ± 14.3 vs. 10.6 ± 7.4; p = 0.019). Percentage spent in a particular position during CRRT was not significantly different between two groups. On multivariable linear regression analysis, mean circuit life was significantly and positively correlated with right vascular access site (p = 0.03) and lower platelet count (p = 0.03), but not with patient position.
  
  
  CONCLUSIONS
  Right-sided insertion but not time spent in a particular position significantly affects circuit life during CRRT with femoral vein access.
authors.affiliation: Department of Intensive Care Medicine, Austin Hospital, Studley Road, Melbourne, VIC 3084, Australia.
authors.forename: In Byung
authors.initials: IB
authors.lastname: Kim
authors.forename: Nigel
authors.initials: N
authors.lastname: Fealy
authors.forename: Ian
authors.initials: I
authors.lastname: Baldwin
authors.forename: Rinaldo
authors.initials: R
authors.lastname: Bellomo
mesh_terms: D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D001777:Blood Coagulation; D015331:Cohort Studies; D004868:Equipment Failure; D005260:Female; D005268:Femoral Vein / Q000378:metabolism*; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D010314:Partial Thromboplastin Time; D056888:Patient Positioning; D010976:Platelet Count; D017582:Renal Replacement Therapy / Q000295:instrumentation / Q000379:methods*
chemical_list: D000925:Anticoagulants