Anticoagulation in continuous renal replacement therapy.

Continuous renal replacement therapy (CRRT) is a specialized intervention that is managed largely by critical care nurses who are educated in the theoretical and practical aspects of the therapy. CRRT is most commonly indicated for hemodynamically unstable patients who have acute renal failure and a narrow margin of tolerance for the rapid fluid shifts associated with traditional dialysis. Although the utilization of CRRT in the critical care setting is becoming more widespread, numerous factors need to be considered before therapy is initiated. The use of anticoagulation is a concern because of the associated risk of bleeding and thrombocytopenia. Nurses at the bedside must be expert in both managing CRRT and assisting in identifying patients who may be at potential risk when this form of treatment is in place. An overview of possible anticoagulants for use in CRRT is outlined in this article.