Une voie simple et sécurisée pour la réalisation de l ... au citrate_ertic_2.pdf · A Set of...

Une voie simple et Une voie simple et sséécuriscuriséée pour la re pour la rééalisationalisation

de lde l’’anticoagulationanticoagulationrréégionale au Citrategionale au Citrate

CiCi--Ca Ca therapytherapy systemsystem

Pompes Citrate et Calcium IntPompes Citrate et Calcium Intéégrgrééeses

•• Infusion Citrate Infusion Citrate asservie au asservie au ddéébit sangbit sang

•• Infusion de CalciumInfusion de Calciumasservie asservie àà ll’é’épurationpurationde calciumde calcium

•• Contrôle de toutes Contrôle de toutes

les pompes par les pompes par un seul systun seul systèème me en cas den cas d’’alarmesalarmes

SafetySafety increasedincreased byby integrationintegrationof of thethe citratecitrate and and calciumcalcium pumpspumps

ControlControl of of thetheCiCi--CaCa pumpspumpsvia via thethe useruser

interfaceinterface of of thethemultiFiltratemultiFiltrate

Calcium pump

Citrate pumpand

Pump Pump rotorrotor

SwitchSwitch forfor automaticautomaticpumplinepumpline handlinghandling

CiCi--CaCa®® ModuleModule

CounterCounter dropsdrops

MultiFiltrateMultiFiltrate CiCi--CaCa®®: Completely : Completely Integrated Citrate AnticoagulationIntegrated Citrate Anticoagulation

•• CiCi--CaCa®® Module as extension for the Module as extension for the multiFiltratemultiFiltrate•• Citrate and calcium pumps controlled by the Citrate and calcium pumps controlled by the

multiFiltrate, infused volumes automatically included in multiFiltrate, infused volumes automatically included in the fluid balancethe fluid balance

•• Safe alarm handlingSafe alarm handling•• Control of the treatment via a single intuitive user Control of the treatment via a single intuitive user

interfaceinterface

•• CiCi--CaCa®® CassetteCassette•• Dedicated disposable for a safe Dedicated disposable for a safe

CiCi--CaCa®® TreatmentTreatment•• PrePre--connected citrate and calcium lines ensure correct connected citrate and calcium lines ensure correct

connection of the extracorporeal circuit to the catheterconnection of the extracorporeal circuit to the catheter

•• CiCi--CaCa®® Dialysate K2Dialysate K2•• Adjusted dialysis fluid with adapted sodium and Adjusted dialysis fluid with adapted sodium and

bicarbonate concentrationsbicarbonate concentrations•• Calcium free for an effective anticoagulationCalcium free for an effective anticoagulation

SSéécuriscuriséé et ergonomiqueet ergonomique

•• Pompes Citrate et Calcium intPompes Citrate et Calcium intéégrgrééeses•• Infusion de Citrate asservie au dInfusion de Citrate asservie au déébit sangbit sang•• Infusion de Calcium asservie au calcium Infusion de Calcium asservie au calcium éépurpuréé•• Contrôle de toutes les pompes par un seul systContrôle de toutes les pompes par un seul systèème me

en cas den cas d’’alarmesalarmes

•• Interface utilisateur adaptInterface utilisateur adaptééee•• Prescription facile du traitement CiPrescription facile du traitement Ci--CaCa®®

•• Aide utilisateur intuitifAide utilisateur intuitif•• Instruction de montage Instruction de montage àà ll’é’écrancran

•• Cassette CiCassette Ci--CaCa®® ddéédidiéée incluant e incluant des caractdes caractééristiques de sristiques de séécuritcuritéé::•• Lignes citrate et calcium PrLignes citrate et calcium Préé--connectconnectééeses•• Lignes guidLignes guidéées sur la cassettees sur la cassette•• Code CouleurCode Couleur

MultiFiltrateMultiFiltrate CiCi--CaCa®® System:System:A Set of Matching ComponentsA Set of Matching Components

CiCi--Ca Dialysate K2Ca Dialysate K2The dialysis fluid for CiThe dialysis fluid for Ci--Ca CVVHDCa CVVHD

•• Sodium and bicarbonate reduced, Sodium and bicarbonate reduced, in order to compensate the in order to compensate the systemic infusion of Nasystemic infusion of Na33CitrateCitrate

•• CalciumCalcium--free, to avoid an unnecessary free, to avoid an unnecessary increase of the citrate requirementincrease of the citrate requirement=> Ca=> Ca--substitution mandatorysubstitution mandatory

•• Packaging in a doublePackaging in a double--chamber bagchamber bag

Na+ 133 mmol/lK+ 2 mmol/lMg++ 0.75 mmol/lCa++ 0 mmol/lHCO3

- 20 mmol/lCl 116.5 mmol/lGlukose 1 g/l

SetSet--up of up of thethe bloodblood and and effluenteffluent lineslinesSetSet--up of up of thethe CiCi--Ca Ca lineslinesCompleteComplete setset--upup

MultiFiltrateMultiFiltrate CiCi--CaCa®® CassetteCassette::ComprehensiveComprehensive SetSet--Up Up InstructionsInstructions

Programmation simple du traitementProgrammation simple du traitement

Dose CitrateDose CitrateAjustement de lAjustement de l’’anti anti

coagulation rcoagulation réégionalegionale

Dose CalciumDose CalciumAjustement du Ajustement du

calcium calcium

DDéébits sang et bits sang et dialysatdialysat

Ajustement de Ajustement de ll’é’équilibre quilibre acideacide--basebase

multiFiltrate CimultiFiltrate Ci--CaCa®® System:System:

•• Regional anticoagulation with citrate has been successfully Regional anticoagulation with citrate has been successfully used in continuous renal replacement therapy for a few years used in continuous renal replacement therapy for a few years now without any serious problems.now without any serious problems.

•• More than 20,000More than 20,000 CiCi--Ca Ca treatments still done today with treatments still done today with

the the multiFiltratemultiFiltrate systemsystem

Adjustment of the Adjustment of the citrate and calcium dosecitrate and calcium dose

Citrate Dose: Citrate Dose: IncreasedIncreased SafetySafetybyby OnOn--Screen SupportScreen Support

Citrate dose [mmol/l]Citrate dose [mmol/l]

0.00.0––1.91.9SettingSetting

notnot possiblepossible

2.02.0––2.92.9UnusuallyUnusually lowlowbutbut possiblepossible

3.03.0––5.05.0Expected Expected

rangerange

5.15.1––6.06.0UnusuallyUnusually highhighbutbut possiblepossible

>6.0>6.0SettingSetting

notnot possiblepossible

Calcium Dose: Calcium Dose: IncreasedIncreased SafetySafetybyby OnOn--Screen SupportScreen Support

00––1.21.2NegativeNegative

calciumcalcium balancebalance

1.31.3––2.12.1ExpectedExpected

rangerange

2.22.2––3.03.0Positive Positive calciumcalcium

balancebalance oror signsign forforcitratecitrate accumulationaccumulation

>3.0>3.0SettingSetting notnot possiblepossible::ConsiderConsider changechange of of

treatmenttreatment modemode

Calcium dose [mmol/l]Calcium dose [mmol/l]

20% 20% changechange of of bloodblood oror dialysatedialysate flowflow

=> => approxapprox. 4 mmol/l . 4 mmol/l changechange

of of thethe acidacid--basebase statusstatus

CiCi--CaCa CVVHD: CVVHD: Effect of blood and Effect of blood and dialysate flow on the aciddialysate flow on the acid--base statusbase status

Constant treatment parameters:Citrate dose 3.7 mmol/l, calcium dose 1.7 mmol/l, net fluid removal 100 ml/hVariability between patients not considered

Fresenius Medical CareInternal calculations

CiCi--CaCa CVVHD: CVVHD: Effect of blood and Effect of blood and dialysate flow on the aciddialysate flow on the acid--base statusbase status

PrescribedPrescribedCVVHD dose: CVVHD dose:

3000 ml/h3000 ml/h

Normal Normal acidacid--basebase

statusstatusaimedaimed--atat

RequiredRequiredbloodblood flowflow::150 ml/min150 ml/min

Constant treatment parameters:Citrate dose 3.7 mmol/l, calcium dose 1.7 mmol/l, net fluid removal 100 ml/hVariability between patients not considered

Fresenius Medical CareInternal calculations

multiFiltrate CimultiFiltrate Ci--CaCa®® System: System: Correction of Metabolic AcidosisCorrection of Metabolic Acidosis

MoreMorebloodbloodflowflow

LessLessdialysatedialysate

flowflow or

multiFiltrate CimultiFiltrate Ci--CaCa®® System: System: Correction of Metabolic AlkalosisCorrection of Metabolic Alkalosis

LessLessbloodbloodflowflow

MoreMoredialysatedialysate

flowflow or

Increasing the Efficacy Increasing the Efficacy of Ciof Ci--CaCa®® CVVHDCVVHD

MoreMorebloodbloodflowflow

MoreMoredialysatedialysate

flowflow and

En En pratiquepratique

••Normal rangesNormal ranges•• pH:pH: 7.357.35 –– 7.457.45•• Base excess:Base excess: --2.02.0 –– +2.0 +2.0 mmol/lmmol/l•• Systemic Systemic ionisedionised Ca: Ca: 1.12 1.12 –– 1.20 1.20 mmol/lmmol/l•• Systemic total Ca: Systemic total Ca: 2.2 2.2 –– 2.5 2.5 mmol/lmmol/l

•• Instructions for the dosing adaptationInstructions for the dosing adaptation

dd.mm hh:mm ml/min ml/h mmol/l mmol/l ml/h mmol/l mmol/l mmol/l mmol/l pH-units

5-Nov 15:00 100 2000 4.0 1.7 100

Systemic total Ca

Base excess

Date Time pHBlood flow

Dialy-sate

Citrate dose

Calciumdose

Net-UF Postfilter ionised

Ca

Systemic ionised

Ca

dd.mm hh:mm ml/min ml/h mmol/l mmol/l ml/h mmol/l mmol/l mmol/l mmol/l pH-units

5-Nov 15:00 100 2000 4.0 1.7 100

5-Nov 15:05 0.38

Systemic total Ca

Base excess

Date Time pHBlood flow

Dialy-sate

Citrate dose

Calciumdose

Net-UF Postfilter ionised

Ca

Systemic ionised

Ca

Patient 1Patient 1

dd.mm hh:mm ml/min ml/h mmol/l mmol/l ml/h mmol/l mmol/l mmol/l mmol/l pH-units

5-Nov 15:00 100 2000 4.0 1.7 100

5-Nov 15:05 100 2000 4.1 1.7 100 0.38

Date Time pHBlood flow

Dialy-sate

Citrate dose

Calciumdose

Net-UF Postfilter ionised

Ca

Systemic ionised

Ca

Systemic total Ca

Base excess

dd.mm hh:mm ml/min ml/h mmol/l mmol/l ml/h mmol/l mmol/l mmol/l mmol/l pH-units

5-Nov 15:00 100 2000 4.0 1.7 100

5-Nov 15:05 100 2000 4.1 1.7 100 0.38

5-Nov 21:00 0.22 1.06 2.24 +1.8 7.42

Systemic total Ca

Base excess

Date Time pHBlood flow

Dialy-sate

Citrate dose

Calciumdose

Net-UF Postfilter ionised

Ca

Systemic ionised

Ca

dd.mm hh:mm ml/min ml/h mmol/l mmol/l ml/h mmol/l mmol/l mmol/l mmol/l pH-units

5-Nov 15:00 100 2000 4.0 1.7 100

5-Nov 15:05 100 2000 4.1 1.7 100 0.38

5-Nov 21:00 100 2000 4.0 1.9 100 0.22 1.06 2.24 +1.8 7.42

pHBlood flow

Dialy-sate

Citrate dose

Calciumdose

Net-UF Postfilter ionised

Ca

Systemic ionised

Ca

Systemic total Ca

Base excess

Date Time

Patient 1Patient 1

dd.mm hh:mm ml/min ml/h mmol/l mmol/l ml/h mmol/l mmol/l mmol/l mmol/l pH-units

5-Nov 15:00 100 2000 4.0 1.7 100

5-Nov 15:05 100 2000 4.1 1.7 100 0.38

5-Nov 21:00 100 2000 4.0 1.9 100 0.22 1.06 2.24 +1.8 7.42

6-Nov 03:00 0.27 1.13 2.34 +1.8 7.43

pHBlood flow

Dialy-sate

Citrate dose

Calciumdose

Net-UF Postfilter ionised

Ca

Systemic ionised

Ca

Systemic total Ca

Base excess

Date Time

dd.mm hh:mm ml/min ml/h mmol/l mmol/l ml/h mmol/l mmol/l mmol/l mmol/l pH-units

5-Nov 15:00 100 2000 4.0 1.7 100

5-Nov 15:05 100 2000 4.1 1.7 100 0.38

5-Nov 21:00 100 2000 4.0 1.9 100 0.22 1.06 2.24 +1.8 7.42

6-Nov 03:00 100 2000 4.0 1.9 100 0.27 1.13 2.34 +1.8 7.43

Date Time pHBlood flow

Dialy-sate

Citrate dose

Calciumdose

Net-UF Postfilter ionised

Ca

Systemic ionised

Ca

Systemic total Ca

Base excess

dd.mm hh:mm ml/min ml/h mmol/l mmol/l ml/h mmol/l mmol/l mmol/l mmol/l pH-units

5-Nov 15:00 100 2000 4.0 1.7 100

5-Nov 15:05 100 2000 4.1 1.7 100 0.38

5-Nov 21:00 100 2000 4.0 1.9 100 0.22 1.06 2.24 +1.8 7.42

6-Nov 03:00 100 2000 4.0 1.9 100 0.27 1.13 2.34 +1.8 7.43

6-Nov 09:00 0.26 1.15 2.34 +3.7 7.48

Systemic total Ca

Base excess

Date Time pHBlood flow

Dialy-sate

Citrate dose

Calciumdose

Net-UF Postfilter ionised

Ca

Systemic ionised

Ca

dd.mm hh:mm ml/min ml/h mmol/l mmol/l ml/h mmol/l mmol/l mmol/l mmol/l pH-units

5-Nov 15:00 100 2000 4.0 1.7 100

5-Nov 15:05 100 2000 4.1 1.7 100 0.38

5-Nov 21:00 100 2000 4.0 1.9 100 0.22 1.06 2.24 +1.8 7.42

6-Nov 03:00 100 2000 4.0 1.9 100 0.27 1.13 2.34 +1.8 7.43

6-Nov 09:00 90 2000 4.0 1.9 100 0.26 1.15 2.34 +3.7 7.48

Systemic total Ca

Base excess

Date Time pHBlood flow

Dialy-sate

Citrate dose

Calciumdose

Net-UF Postfilter ionised

Ca

Systemic ionised

Ca

dd.mm hh:mm ml/min ml/h mmol/l mmol/l ml/h mmol/l mmol/l mmol/l mmol/l pH-units

5-Nov 15:00 100 2000 4.0 1.7 100

5-Nov 15:05 100 2000 4.1 1.7 100 0.38

5-Nov 21:00 100 2000 4.0 1.9 100 0.22 1.06 2.24 +1.8 7.42

6-Nov 03:00 100 2000 4.0 1.9 100 0.27 1.13 2.34 +1.8 7.43

6-Nov 09:00 90 2000 4.0 1.9 100 0.26 1.15 2.34 +3.7 7.48

6-Nov 15:00 0.26 1.15 2.34 +2.2 7.44

pHBlood flow

Dialy-sate

Citrate dose

Calciumdose

Net-UF Postfilter ionised

Ca

Systemic ionised

Ca

Systemic total Ca

Base excess

Date Time

dd.mm hh:mm ml/min ml/h mmol/l mmol/l ml/h mmol/l mmol/l mmol/l mmol/l pH-units

5-Nov 15:00 100 2000 4.0 1.7 100

5-Nov 15:05 100 2000 4.1 1.7 100 0.38

5-Nov 21:00 100 2000 4.0 1.9 100 0.22 1.06 2.24 +1.8 7.42

6-Nov 03:00 100 2000 4.0 1.9 100 0.27 1.13 2.34 +1.8 7.43

6-Nov 09:00 90 2000 4.0 1.9 100 0.26 1.15 2.34 +3.7 7.48

6-Nov 15:00 90 2000 4.0 1.9 100 0.26 1.15 2.34 +2.2 7.44

Date Time pHBlood flow

Dialy-sate

Citrate dose

Calciumdose

Net-UF Postfilter ionised

Ca

Systemic ionised

Ca

Systemic total Ca

Base excess

dd.mm hh:mm ml/min ml/h mmol/l mmol/l ml/h mmol/l mmol/l mmol/l mmol/l pH-units

5-Nov 15:00 100 2000 4.0 1.7 100

pHBlood flow

Dialy-sate

Citrate dose

Calciumdose

Net-UF Postfilter ionised

Ca

Systemic ionised

Ca

Systemic total Ca

Base excess

Date Time

Patient 2Patient 2

dd.mm hh:mm ml/min ml/h mmol/l mmol/l ml/h mmol/l mmol/l mmol/l mmol/l pH-units

5-Nov 15:00 100 2000 4.0 1.7 100

5-Nov 15:05 0.27

Date Time pHBlood flow

Dialy-sate

Citrate dose

Calciumdose

Net-UF Postfilter ionised

Ca

Systemic ionised

Ca

Systemic total Ca

Base excess

dd.mm hh:mm ml/min ml/h mmol/l mmol/l ml/h mmol/l mmol/l mmol/l mmol/l pH-units

5-Nov 15:00 100 2000 4.0 1.7 100

5-Nov 15:05 100 2000 4.0 1.7 100 0.27

Systemic total Ca

Base excess

Date Time pHBlood flow

Dialy-sate

Citrate dose

Calciumdose

Net-UF Postfilter ionised

Ca

Systemic ionised

Ca

dd.mm hh:mm ml/min ml/h mmol/l mmol/l ml/h mmol/l mmol/l mmol/l mmol/l pH-units

5-Nov 15:00 100 2000 4.0 1.7 100

5-Nov 15:05 100 2000 4.0 1.7 100 0.27

5-Nov 21:00 0.18 1.02 2.34 -1.2 7.37

pHBlood flow

Dialy-sate

Citrate dose

Calciumdose

Net-UF Postfilter ionised

Ca

Systemic ionised

Ca

Systemic total Ca

Base excess

Date Time

dd.mm hh:mm ml/min ml/h mmol/l mmol/l ml/h mmol/l mmol/l mmol/l mmol/l pH-units

5-Nov 15:00 100 2000 4.0 1.7 100

5-Nov 15:05 100 2000 4.0 1.7 100 0.27

5-Nov 21:00 100 2000 3.8 2.1 100 0.18 1.02 2.34 -1.2 7.37

Date Time pHBlood flow

Dialy-sate

Citrate dose

Calciumdose

Net-UF Postfilter ionised

Ca

Systemic ionised

Ca

Systemic total Ca

Base excess

dd.mm hh:mm ml/min ml/h mmol/l mmol/l ml/h mmol/l mmol/l mmol/l mmol/l pH-units

5-Nov 15:00 100 2000 4.0 1.7 100

5-Nov 15:05 100 2000 4.0 1.7 100 0.27

5-Nov 21:00 100 2000 3.8 2.1 100 0.18 1.02 2.34 -1.2 7.37

6-Nov 03:00 0.22 1.05 2.42 -1.8 7.36

Systemic total Ca

Base excess

Date Time pHBlood flow

Dialy-sate

Citrate dose

Calciumdose

Net-UF Postfilter ionised

Ca

Systemic ionised

Ca

Patient 2Patient 2

dd.mm hh:mm ml/min ml/h mmol/l mmol/l ml/h mmol/l mmol/l mmol/l mmol/l pH-units

5-Nov 15:00 100 2000 4.0 1.7 100

5-Nov 15:05 100 2000 4.0 1.7 100 0.27

5-Nov 21:00 100 2000 3.8 2.1 100 0.18 1.02 2.34 -1.2 7.37

6-Nov 03:00 100 2000 3.7 2.3 100 0.22 1.05 2.42 -1.8 7.36

Systemic total Ca

Base excess

Date Time pHBlood flow

Dialy-sate

Citrate dose

Calciumdose

Net-UF Postfilter ionised

Ca

Systemic ionised

Ca

dd.mm hh:mm ml/min ml/h mmol/l mmol/l ml/h mmol/l mmol/l mmol/l mmol/l pH-units

5-Nov 15:00 100 2000 4.0 1.7 100

5-Nov 15:05 100 2000 4.0 1.7 100 0.27

5-Nov 21:00 100 2000 3.8 2.1 100 0.18 1.02 2.34 -1.2 7.37

6-Nov 03:00 100 2000 3.7 2.3 100 0.22 1.05 2.42 -1.8 7.36

6-Nov 09:00 0.25 1.08 2.46 -2.9 7.33

pHBlood flow

Dialy-sate

Citrate dose

Calciumdose

Net-UF Postfilter ionised

Ca

Systemic ionised

Ca

Systemic total Ca

Base excess

Date Time

dd.mm hh:mm ml/min ml/h mmol/l mmol/l ml/h mmol/l mmol/l mmol/l mmol/l pH-units

5-Nov 15:00 100 2000 4.0 1.7 100

5-Nov 15:05 100 2000 4.0 1.7 100 0.27

5-Nov 21:00 100 2000 3.8 2.1 100 0.18 1.02 2.34 -1.2 7.37

6-Nov 03:00 100 2000 3.7 2.3 100 0.22 1.05 2.42 -1.8 7.36

6-Nov 09:00 110 2000 3.7 2.3 100 0.25 1.08 2.46 -2.9 7.33

Date Time pHBlood flow

Dialy-sate

Citrate dose

Calciumdose

Net-UF Postfilter ionised

Ca

Systemic ionised

Ca

Systemic total Ca

Base excess

dd.mm hh:mm ml/min ml/h mmol/l mmol/l ml/h mmol/l mmol/l mmol/l mmol/l pH-units

5-Nov 15:00 100 2000 4.0 1.7 100

5-Nov 15:05 100 2000 4.0 1.7 100 0.27

5-Nov 21:00 100 2000 3.8 2.1 100 0.18 1.02 2.34 -1.2 7.37

6-Nov 03:00 100 2000 3.7 2.3 100 0.22 1.05 2.42 -1.8 7.36

6-Nov 09:00 110 2000 3.7 2.3 100 0.25 1.08 2.46 -2.9 7.33

6-Nov 15:00 0.23 1.12 2.52 -0.9 7.38

Systemic total Ca

Base excess

Date Time pHBlood flow

Dialy-sate

Citrate dose

Calciumdose

Net-UF Postfilter ionised

Ca

Systemic ionised

Ca

dd.mm hh:mm ml/min ml/h mmol/l mmol/l ml/h mmol/l mmol/l mmol/l mmol/l pH-units

5-Nov 15:00 100 2000 4.0 1.7 100

5-Nov 15:05 100 2000 4.0 1.7 100 0.27

5-Nov 21:00 100 2000 3.8 2.1 100 0.18 1.02 2.34 -1.2 7.37

6-Nov 03:00 100 2000 3.7 2.3 100 0.22 1.05 2.42 -1.8 7.36

6-Nov 09:00 110 2000 3.7 2.3 100 0.25 1.08 2.46 -2.9 7.33

6-Nov 15:00 110 2000 3.6 2.3 100 0.23 1.12 2.52 -0.9 7.38

pHBlood flow

Dialy-sate

Citrate dose

Calciumdose

Net-UF Postfilter ionised

Ca

Systemic ionised

Ca

Systemic total Ca

Base excess

Date Time

dd.mm hh:mm ml/min ml/h mmol/l mmol/l ml/h mmol/l mmol/l mmol/l mmol/l pH-units

5-Nov 15:00 100 2000 4.0 1.7 100

5-Nov 15:05 100 2000 4.0 1.7 100 0.27

5-Nov 21:00 100 2000 3.8 2.1 100 0.18 1.02 2.34 -1.2 7.37

6-Nov 03:00 100 2000 3.7 2.3 100 0.22 1.05 2.42 -1.8 7.36

6-Nov 09:00 110 2000 3.7 2.3 100 0.25 1.08 2.46 -2.9 7.33

6-Nov 15:00 110 2000 3.6 2.3 100 0.23 1.12 2.52 -0.9 7.38

6-Nov 21:00 0.26 1.06 2.52 -1.2 7.39

Date Time pHBlood flow

Dialy-sate

Citrate dose

Calciumdose

Net-UF Postfilter ionised

Ca

Systemic ionised

Ca

Systemic total Ca

Base excess

Patient 2Patient 2

dd.mm hh:mm ml/min ml/h mmol/l mmol/l ml/h mmol/l mmol/l mmol/l mmol/l pH-units

5-Nov 15:00 100 2000 4.0 1.7 100

5-Nov 15:05 100 2000 4.0 1.7 100 0.27

5-Nov 21:00 100 2000 3.8 2.1 100 0.18 1.02 2.34 -1.2 7.37

6-Nov 03:00 100 2000 3.7 2.3 100 0.22 1.05 2.42 -1.8 7.36

6-Nov 09:00 110 2000 3.7 2.3 100 0.25 1.08 2.46 -2.9 7.33

6-Nov 15:00 110 2000 3.6 2.3 100 0.23 1.12 2.52 -0.9 7.38

6-Nov 21:00 110 2000 3.6 2.5 100 0.26 1.06 2.52 -1.2 7.39

Systemic total Ca

Base excess

Date Time pHBlood flow

Dialy-sate

Citrate dose

Calciumdose

Net-UF Postfilter ionised

Ca

Systemic ionised

Ca

dd.mm hh:mm ml/min ml/h mmol/l mmol/l ml/h mmol/l mmol/l mmol/l mmol/l pH-units

5-Nov 15:00 100 2000 4.0 1.7 100

5-Nov 15:05 100 2000 4.0 1.7 100 0.27

5-Nov 21:00 100 2000 3.8 2.1 100 0.18 1.02 2.34 -1.2 7.37

6-Nov 03:00 100 2000 3.7 2.3 100 0.22 1.05 2.42 -1.8 7.36

6-Nov 09:00 110 2000 3.7 2.3 100 0.25 1.08 2.46 -2.9 7.33

6-Nov 15:00 110 2000 3.6 2.3 100 0.23 1.12 2.52 -0.9 7.38

6-Nov 21:00 110 2000 3.6 2.5 100 0.26 1.06 2.52 -1.2 7.39

7-Nov 03:00 0.26 1.10 2.63 -1.0 7.38

pHBlood flow

Dialy-sate

Citrate dose

Calciumdose

Net-UF Postfilter ionised

Ca

Systemic ionised

Ca

Systemic total Ca

Base excess

Date Time

dd.mm hh:mm ml/min ml/h mmol/l mmol/l ml/h mmol/l mmol/l mmol/l mmol/l pH-units

5-Nov 15:00 100 2000 4.0 1.7 100

5-Nov 15:05 100 2000 4.0 1.7 100 0.27

5-Nov 21:00 100 2000 3.8 2.1 100 0.18 1.02 2.34 -1.2 7.37

6-Nov 03:00 100 2000 3.7 2.3 100 0.22 1.05 2.42 -1.8 7.36

6-Nov 09:00 110 2000 3.7 2.3 100 0.25 1.08 2.46 -2.9 7.33

6-Nov 15:00 110 2000 3.6 2.3 100 0.23 1.12 2.52 -0.9 7.38

6-Nov 21:00 110 2000 3.6 2.5 100 0.26 1.06 2.52 -1.2 7.39

7-Nov 03:00 110 2000 3.6 2.7 100 0.26 1.10 2.63 -1.0 7.38

Date Time pHBlood flow

Dialy-sate

Citrate dose

Calciumdose

Net-UF Postfilter ionised

Ca

Systemic ionised

Ca

Systemic total Ca

Base excess

dd.mm hh:mm ml/min ml/h mmol/l mmol/l ml/h mmol/l mmol/l mmol/l mmol/l pH-units

5-Nov 15:00 100 2000 4.0 1.7 100

5-Nov 15:05 100 2000 4.0 1.7 100 0.27

5-Nov 21:00 100 2000 3.8 2.1 100 0.18 1.02 2.34 -1.2 7.37

6-Nov 03:00 100 2000 3.7 2.3 100 0.22 1.05 2.42 -1.8 7.36

6-Nov 09:00 110 2000 3.7 2.3 100 0.25 1.08 2.46 -2.9 7.33

6-Nov 15:00 110 2000 3.6 2.3 100 0.23 1.12 2.52 -0.9 7.38

6-Nov 21:00 110 2000 3.6 2.5 100 0.26 1.06 2.52 -1.2 7.39

7-Nov 03:00 110 2000 3.6 2.7 100 0.26 1.10 2.63 -1.0 7.38

7-Nov 09:00 0.22 1.03 2.65 -2.0 7.35

Systemic total Ca

Base excess

Date Time pHBlood flow

Dialy-sate

Citrate dose

Calciumdose

Net-UF Postfilter ionised

Ca

Systemic ionised

Ca

Treatment stopped due to citrate accumulationTreatment stopped due to citrate accumulation

dd.mm hh:mm ml/min ml/h mmol/l mmol/l ml/h mmol/l mmol/l mmol/l mmol/l pH-units

16-Mai 15:50 100 1500 4.1 1.7 100

Systemic total Ca

Base excess

Date Time pHBlood flow

Dialy-sate

Citrate dose

Calciumdose

Net-UF Postfilter ionised

Ca

Systemic ionised

Ca

dd.mm hh:mm ml/min ml/h mmol/l mmol/l ml/h mmol/l mmol/l mmol/l mmol/l pH-units

16-Mai 15:50 100 1500 4.1 1.7 100 0,25 1.15 2.13 -3.5 7.36

pHBlood flow

Dialy-sate

Citrate dose

Calciumdose

Net-UF Postfilter ionised

Ca

Systemic ionised

Ca

Systemic total Ca

Base excess

Date Time

dd.mm hh:mm ml/min ml/h mmol/l mmol/l ml/h mmol/l mmol/l mmol/l mmol/l pH-units

16-Mai 15:50 100 1500 4.1 1.7 100 0,25 1.15 2.13 -3.5 7.36

16-Mai 17:00device defect 1.15

notmeasured -3.6 7.37

Systemic total Ca

Base excess

Date Time pHBlood flow

Dialy-sate

Citrate dose

Calciumdose

Net-UF Postfilter ionised

Ca

Systemic ionised

Ca

Patient 3Patient 3

dd.mm hh:mm ml/min ml/h mmol/l mmol/l ml/h mmol/l mmol/l mmol/l mmol/l pH-units

16-Mai 15:50 100 1500 4.1 1.7 100 0,25 1.15 2.13 -3.5 7.36

16-Mai 17:00 100 1500 4.1 1.7 100device defect 1.15

notmeasured -3.6 7.37

pHBlood flow

Dialy-sate

Citrate dose

Calciumdose

Net-UF Postfilter ionised

Ca

Systemic ionised

Ca

Systemic total Ca

Base excess

Date Time

dd.mm hh:mm ml/min ml/h mmol/l mmol/l ml/h mmol/l mmol/l mmol/l mmol/l pH-units

16-Mai 15:50 100 1500 4.1 1.7 100 0,25 1.15 2.13 -3.5 7.36

16-Mai 17:00 100 1500 4.1 1.7 100device defect 1.15

notmeasured -3.6 7.37

16-Mai 20:00 0,26 1.12not

measured -4.3 7.32

Date Time pHBlood flow

Dialy-sate

Citrate dose

Calciumdose

Net-UF Postfilter ionised

Ca

Systemic ionised

Ca

Systemic total Ca

Base excess

dd.mm hh:mm ml/min ml/h mmol/l mmol/l ml/h mmol/l mmol/l mmol/l mmol/l pH-units

16-Mai 15:50 100 1500 4.1 1.7 100 0,25 1.15 2.13 -3.5 7.36

16-Mai 17:00 100 1500 4.1 1.7 100device defect 1.15

notmeasured -3.6 7.37

16-Mai 20:00 100 1500 4.1 1.7 100 0,26 1.12not

measured -4.3 7.32

Systemic total Ca

Base excess

Date Time pHBlood flow

Dialy-sate

Citrate dose

Calciumdose

Net-UF Postfilter ionised

Ca

Systemic ionised

Ca

dd.mm hh:mm ml/min ml/h mmol/l mmol/l ml/h mmol/l mmol/l mmol/l mmol/l pH-units

16-Mai 15:50 100 1500 4.1 1.7 100 0,25 1.15 2.13 -3.5 7.36

16-Mai 17:00 100 1500 4.1 1.7 100device defect 1.15

notmeasured -3.6 7.37

16-Mai 20:00 100 1500 4.1 1.7 100 0,26 1.12not

measured -4.3 7.32

17-Mai 06:40 100 1500 3.6 2.2 110 0,19 1.03 2.21 -2.3 7.34

17-Mai 09:00 100 1500 3.6 2.2 110 0,29 1.03not

measured -4.2 7.35

17-Mai 19:10 100 1500 3.7 2.2 110 0,22 1.12not

measured -2.9 7.38

17-Mai 20:00 100 1500 3.5 2.2 110 0,22 1.15not

measured -1.5 7.41

Systemic total Ca

Base excess

Date Time pHBlood flow

Dialy-sate

Citrate dose

Calciumdose

Net-UF Postfilter ionised

Ca

Systemic ionised

Ca

Patient 3Patient 3

dd.mm hh:mm ml/min ml/h mmol/l mmol/l ml/h mmol/l mmol/l mmol/l mmol/l pH-units

16-Mai 15:50 100 1500 4.1 1.7 100 0,25 1.15 2.13 -3.5 7.36

16-Mai 17:00 100 1500 4.1 1.7 100device defect 1.15

notmeasured -3.6 7.37

16-Mai 20:00 100 1500 4.1 1.7 100 0,26 1.12not

measured -4.3 7.32

17-Mai 06:40 100 1500 3.6 2.2 110 0,19 1.03 2.21 -2.3 7.34

17-Mai 09:00 100 1500 3.6 2.2 110 0,29 1.03not

measured -4.2 7.35

17-Mai 19:10 100 1500 3.7 2.2 110 0,22 1.12not

measured -2.9 7.38

17-Mai 20:00 100 1500 3.5 2.2 110 0,22 1.15not

measured -1.5 7.41

18-Mai 02:00 100 1500 3.5 2.2 110 0,25 1.16 2.20 -0.5 7.43

18-Mai 09:00 100 1500 3.5 2.2 110 0,25 1.15not

measured +1.5 7.45

18-Mai 10:05 100 1500 3.5 2.2 110 0,26 1.15not

measured +1.8 7.44

18-Mai 20:00 100 1500 3.5 2.2 110 0,25 1.16not

measured +0.2 7.42

pHBlood flow

Dialy-sate

Citrate dose

Calciumdose

Net-UF Postfilter ionised

Ca

Systemic ionised

Ca

Systemic total Ca

Base excess

Date Time

dd.mm hh:mm ml/min ml/h mmol/l mmol/l ml/h mmol/l mmol/l mmol/l mmol/l pH-units

16-Mai 15:50 100 1500 4.1 1.7 100 0,25 1.15 2.13 -3.5 7.36

16-Mai 17:00 100 1500 4.1 1.7 100device defect 1.15

notmeasured -3.6 7.37

16-Mai 20:00 100 1500 4.1 1.7 100 0,26 1.12not

measured -4.3 7.32

17-Mai 06:40 100 1500 3.6 2.2 110 0,19 1.03 2.21 -2.3 7.34

17-Mai 09:00 100 1500 3.6 2.2 110 0,29 1.03not

measured -4.2 7.35

17-Mai 19:10 100 1500 3.7 2.2 110 0,22 1.12not

measured -2.9 7.38

17-Mai 20:00 100 1500 3.5 2.2 110 0,22 1.15not

measured -1.5 7.41

18-Mai 02:00 100 1500 3.5 2.2 110 0,25 1.16 2.20 -0.5 7.43

18-Mai 09:00 100 1500 3.5 2.2 110 0,25 1.15not

measured +1.5 7.45

18-Mai 10:05 100 1500 3.5 2.2 110 0,26 1.15not

measured +1.8 7.44

18-Mai 20:00 100 1500 3.5 2.2 110 0,25 1.16not

measured +0.2 7.42

19-Mai 04:00 100 1500 3.5 1.9 110 0,27 1.23not

measured +3.0 7.44

19-Mai 08:00 100 1500 3.5 1.9 110 0,27 1.27not

measured +3.0 7.44

19-Mai 10:00

Base excess

Date Time

Retransfusion, CVVHD dismantled

pHBlood flow

Dialy-sate

Citrate dose

Calciumdose

Net-UF Postfilter ionised

Ca

Systemic ionised

Ca

Systemic total Ca

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