EFFECTS OF REGIONAL CITATE ANTICOAGULATION

Product Safety and Quality Mechanical and Machinery Equipment Field Evaluation Services EFFECTS OF ELECTRICAL CURRENT IN THE HUMAN BODY Current Reaction Below 1 Milliampere Generally not perceptible 1 Milliampere Faint Tingle 5 Milliampere Slight shock felt. Not painful but disturbing. Average individual can let go. Strong involuntary reactions can lead to other injuries. 6 to 25 Milliampere (women) Painful shocks. Loss of muscle control. 9 to 30 Milliampere (men) The freezing current or “let go” range. If extensor muscles are excited by shock, the person may be thrown away from the power source. Individuals cannot let go. Strong involuntary reactions can lead to other injuries. 50 to 150 Milliamperes Extreme pain, respiratory arrest, severe muscle reactions. Death is possible. 1.0 to 4.3 Amperes Rhythmic pumping action of the heart ceases. Muscular contraction and nerve damage occur; death is likely. 10 Amperes Cardiac arrest, severe burns, death is probable. Use your electrical smarts and follow these safety Do’s and Don’ts: Do’s Don’ts ü Only use plugs that fit the outlet. ü Make sure that electrical connections are tight. ü Check that the wire insulation is in good condition. ü Keep machines and tools properly lubricated. ü Use extension cords only when necessary and only if they are rated high enough for the application. ü Use waterproof cords outside. ü Only use approved extension lamps. ü Leave at least 3 feet of workspace around electrical equipment for instant access. ü Keep your work area clean. Be especially careful with oily rags, paper, sawdust, or anything that could burn. ü Follow manufacturer’s instructions for all electrical equipment. ü Leave electrical repairs to skilled maintenance personnel and licensed electricians. ü Don’t overload outlets or motors. ü Don’t let grease, dust, or dirt build up on machinery. ü Don’t place cords near heat or water. ü Don’t run cords along the floor where they can be damaged. ü Don’t touch anything electric with wet hands. ü Don’t put anything but an electric plug into an electric outlet. ü Don’t use temporary wiring in place of permanent wiring. If the equipment that in installed within your jurisdiction is not NRTL-Listed, AHJ inspectors are well advised to be more vigilant about the hazards of electric shock and should require a third-party inspection by an accredited test Lab. For more information, Please contact TUV Rheinland of North America, Inc. 12 Commerce Road Newtown, CT 06470 TEL: 203-426-0888 / FAX: 203-426-4009 Email: info@tuv.com or call 1-TUV-RHEINLAND REGIONAL CITRATE ANTICOAGULATION IN CONTINUOUS RENAL REPLACEMENT THERAPY INFECTIOUS DISEASE DEPARTMENT - 2017 Coagulation cascade • Population: Patients admitted to ICU with AKI that required CRRT • Intervention: Regional citrate vs heparin anticoagulation in CRRT • RCTs with 488 patients were identified CIRCUIT SURVIVAL TIME INCIDENCE OF MAJOR BLEEDING INCIDENCE OF METABOLIC ALKALOSIS INCIDENCE OF HYPOCALCEMIA Conclusion: • The efficacy of citrate and heparin anticoagulation for CRRT was similar • Citrate anticoagulation decreased the risk of bleeding with no significant increase in the incidence of metabolic alkalosis • We recommend citrate as an anticoagulation agent in patients who require CRRT but are at high risk of bleeding CIRCUIT LIFE SPAN RISK OF BLEEDING Metabolic events • Hypernatremia: was neglectable and occurred equally in both groups • Alkalosis: two studies reported more episodes of alkalosis in the citrate group, another two reported more such events in the control group • Systemic hypo-calcemia: occurred more frequently in the citrate group, which however could be resolved easily and caused no clinically important consequences Mortality Two studies: • Mortality rates per day were similar between the two groups during both treatment and follow-up period (3.1 vs 3.1% and 3.8 vs 3.4%, respectively) • Compared with nadroparin, citrate could reduce both hospital and 3-month mortality by 15% (P