ArticleBMC nursing2025
Saline flushing to prevent circuit clotting during CRRT without anticoagulant: a randomized controlled study.
Article in BMC nursing, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers, 1 of them a synthesis that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
2 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Regional Citrate Anticoagulation Versus No Anticoagulation During Continuous Renal Replacement Therapy in Critically Ill Patients at High Risk of Bleeding: A Meta-analysis of Randomized Controlled Trials.Advances in therapy · 2026Pooled it
- Higher blood flow rates in anticoagulation-free CRRT improve circuit survival and clinical outcome.Clinical kidney journal · 2026Article
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Authors and funding
13 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundRegional citrate anticoagulation (RCA) is the preferred strategy during continuous renal replacement therapy (CRRT). However, saline flushing is often used when anticoagulants are contraindicated, although its effectiveness remains uncertain. This study evaluated the efficacy of different saline flushing strategies in preventing circuit clotting during anticoagulant-free CRRT in critically ill patients.
methodsThis prospective, three-arm randomized controlled trial included critically ill patients initiating CRRT who had contraindications to anticoagulants. Patients were randomized into three groups: 30-minute flush (200 mL every 30 minutes), 2-hour flush (200 mL every 2 hours), or no flush. The primary outcome was circuit lifespan. The secondary outcomes included the delivered CRRT dose, filtration fraction, nurse satisfaction, length of hospital stay, 28-day mortality, and hypotension incidence within 2 hours of CRRT initiation.
resultsAmong 144 randomized patients, 117 (81%) completed the trial: 38 in the 30-minute flush group, 37 in the 2-hour flush group, and 42 in the no-flush group. The mean circuit lifespan was shorter in the 30-minute group (31.03 ± 20.26 h) than in the 2-hour (41.96 ± 18.26 h) and no-flush groups (42.10 ± 19.29 h)(p < 0.05). Significant differences were observed among the 30-minute flush, 2-hour flush, and no-flush groups in terms of delivered CRRT dose (89%, 95% vs. 98%, p < 0.001), filtration fraction (16.14%, 14.05% vs. 13.07%, p < 0.001), and nurse satisfaction (32.26, 62.04 vs. 93.93, p < 0.001). The 30-minute flush group had a higher hypotension incidence within 2 hours of CRRT initiation compared to the no-flush group (71.05% vs. 42.85%, p < 0.017, Bonferroni-adjusted). No significant differences were found in the number of clotting-free patients at 72 hours, hospital stay, or 28-day mortality (p > 0.05).
conclusionsFrequent saline flushing does not appear to effectively prevent circuit clotting and may be associated with increased hypotension, reduced delivered CRRT dose, higher filtration fraction, and lower nurse satisfaction. These findings suggest that saline flushing should be used cautiously in anticoagulant-free CRRT.
trial registrationChinese Clinical Trial Registry:ChiCTR2400080111(01/20/2024).
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