Time course of activated coagulation time at various sites during continuous haemodiafiltration using nafamostat mesilate.

Abstract

To determine the adequate site of activated coagulation time (ACT) measurement during continuous haemodiafiltration (CHDF) using nafamostat mesilate. Prospective, consecutive, clinical study. An intensive care unit of a general hospital. Ten patients with acute organ failure including kidney, lung and liver, caused by sepsis after major surgery. A CHDF circuit with a haemofilter made of polymethylmethacrylate membrane was primed with 50 mg nafamostat in 500 ml saline, and was started at a circuit flow rate of 100 ml/min. Continuous injection of 0.5 mg/kg per h nafamostat, 700 ml/h of dialysis fluid and 1000 ml/h of filtrate fluid was set. The circuit pressure at the inlet and outlet of the circuit were monitored, and ACT was measured every 2 h at the site of nafamostat injection, outlet, patient's artery and inlet until 24 h. A value of standard deviation of ACT at each site was regarded as the variation value of ACT. The circuit pressure did not change significantly. The ACT did not change significantly at any measurement site. The variation value of ACT at the inlet of the circuit was significantly lower than that at the site of nafamostat injection. The ACT value at the inlet of the circuit may be adequate to monitor anticoagulation during CHDF using nafamostat.