成人重症患者连续性肾脏替代治疗抗凝护理操作专家共识

doi:10.3761/j.issn.2096-7446.2026.08.010

Abstract

Abstract:

Objective To develop the “Expert consensus on anticoagulation nursing operations for continuous renal replacement therapy in adult critical care patients”（hereinafter referred to as the consensus），to standardize the implementation and monitoring of anticoagulation techniques in continuous renal replacement therapy（CRRT） for adult critical care patients，and to summarize the key points of nursing for anticoagulation techniques in CRRT for adult critical care patients. Methods Literature related to anticoagulation techniques in CRRT was reviewed both domestically and internationally，and combined with the work experience of clinical nursing experts，a preliminary version of the consensus was formed. Through two rounds of expert consultation，the document was organized and revised to form the final version of the consensus. Results The consensus includes the mechanisms of action of systemic and local anticoagulants in CRRT，the formulation of anticoagulants，the connection between systemic and local anticoagulants，the connection between CRRT and extracorporeal membrane oxygenation（ECMO） and anticoagulation care，anticoagulation monitoring during anticoagulation，and observation and care of common complications. Conclusion The consensus has certain scientific and practical significance，and can provide clinical guidance for anticoagulation nursing and operations in CRRT for adult critical care patients.

Key words: Adult, Critical Care Patients, Continuous Renal Replacement Therapy, Anticoagulation, Nursing Operations, Expert Consensus

Sepsis Nursing Professional Committee of Guangdong Nursing Association, Writer committee：BAI Liping, WEI Zhengdeng, XU Yajun, ZHANG Mengdi, LI Weilin, DONG Qiongfang, CHENG Shouzhen. Expert consensus on anticoagulation nursing operations for continuous renal replacement therapy in adult critical care patients[J]. Chinese Journal of Emergency and Critical Care Nursing, 2026, 7(8): 959-965.

Figures/Tables 2

References 35

[1]	Claudio Ronco, 张凌, 陆任华, 等. 重症肾脏替代治疗和血液净化技术的标准化术语命名[J]. 华西医学, 2018, 33(7):782-796.
	Ronco C, Zhang L, Lu RH, et al. Nomenclature for renal replacement therapy and blood purification techniques in critically ill patients[J]. West China Med J, 2018, 33(7):782-796.
[2]	Rabindranath K, Adams J, MacLeod AM, et al. Intermittent versus continuous renal replacement therapy for acute renal failure in adults[J]. Cochrane Database Syst Rev, 2007(3):CD003773.
[3]	Schneider AG, Bellomo R, Bagshaw SM, et al. Choice of renal replacement therapy modality and dialysis dependence after acute kidney injury:a systematic review and meta-analysis[J]. Intensive Care Med, 2013, 39(6):987-997. doi: 10.1007/s00134-013-2864-5 pmid: 23443311
[4]	Monti G, Herrera M, Kindgen-Milles D, et al. The DOse RE-sponse multicentre international collaborative initiative(DO-RE-MI)[J]. Contrib Nephrol, 2007, 156:434-443. pmid: 17464155
[5]	Khwaja A. KDIGO clinical practice guidelines for acute kidney injury[J]. Nephron Clin Pract, 2012, 120(4):c179-c184.
[6]	查丽玲, 周松, 江榕. ICU行枸橼酸抗凝CRRT病人非计划性下机影响因素研究[J]. 护理研究, 2018, 32(18):2926-2930.
	Zha LL, Zhou S, Jiang R. Study on influencing factors of unplanned downtime of citrate anticoagulation CRRT in ICU patients[J]. Chin Nurs Res, 2018, 32(18):2926-2930.
[7]	李克佳, 胡军, 苏琳, 等. 重症患者连续性肾脏替代治疗非计划下机的相关因素研究[J]. 中国血液净化, 2020, 19(9):645-648.
	Li KJ, Hu J, Su L, et al. Related factors of unexpected interruption of continuous renal replacement therapy in critical care patients[J]. Chin J Blood Purif, 2020, 19(9):645-648.
[8]	胡雁, 郝玉芳. 循证护理学[M]. 2版. 北京: 人民卫生出版社, 2018.
	Hu Y, Hao YF. Evidence-based nursing[M]. 2nd ed. Beijing: People’s Medical Publishing House, 2018.
[9]	Liu SY, Xu SY, Yin L, et al. Management of regional citrate anticoagulation for continuous renal replacement therapy:guideline recommendations from Chinese emergency medical doctor consensus[J]. Mil Med Res, 2023, 10(1):23.
[10]	中华医学会肾脏病学分会专家组. 连续性肾脏替代治疗的抗凝管理指南[J]. 中华肾脏病杂志, 2022, 38(11):1016-1024.
	Chinese Medical Association Nephrology Society Expert Group. Guidelines for the anticoagulant management of continuous renal replacement therapy[J]. Chin J Nephrol, 2022, 38(11):1016-1024. doi: 10.3760/cma.j.cn441217-20220620-00149
[11]	Harth A, Willam C, Jörres A. S3-leitlinie nierenersatztherapie in der intensivmedizin[J]. Die Nephrol, 2025, 20(6):454-461. doi: 10.1007/s11560-025-00880-0
[12]	共识专家组. 抗凝技术在危重症肾脏替代治疗应用的中国专家共识(2023年版)[J]. 中华肾脏病杂志, 2023, 39(2):155-164. doi: 10.3760/cma.j.cn441217-20220809-00815
	Consensus Expert Group. Chinese expert consensus on the application of anticoagulant technology in renal replacement therapy for critical patients(2023)[J]. Chin J Nephrol, 2023, 39(2):155-164. doi: 10.3760/cma.j.cn441217-20220809-00815
[13]	李燕, 莫伟, 葛静萍. 抗凝剂皮下注射护理规范专家共识[J]. 介入放射学杂志, 2019, 28(8):709-716.
	Li Y, Mo W, Ge JP, et al. Expert consensus on nursing standards for subcutaneous injection of anticoagulant agents[J]. J Interv Radiol, 2019, 28(8):709-716.
[14]	四川省国际交流促进会肾脏分会专家组. 连续性肾脏替代治疗医院感染防控专家共识[J]. 华西医学, 2023, 38(7):961-968.
	Nephrology Branch of Sichuan International Medical Exchange & Promotion Association. Expert consensus on hospital infection prevention and control in continuous renal replacement therapy[J]. West China Med J, 2023, 38(7):961-968.
[15]	中国医师协会体外生命支持专业委员会. 成人体外膜氧合循环辅助专家共识[J]. 中华重症医学电子杂志(网络版), 2018, 4(2):114-122.
	Chinese Medical Association Extracorporeal Life Support Professional Committee. Expert consensus on assisting extracorporeal membrane oxygenation circulation in adults[J]. Chin J Crit Care Intensive Care Med Electron Ed, 2018, 4(2):114-122.
[16]	肇冬梅, 马晓春. 血液净化:抗凝的策略[J]. 中国实用内科杂志, 2023, 43(12):996-999.
	Zhao DM, Ma XC. Blood purification:strategies for anticoagulation[J]. Chin J Pract Intern Med, 2023, 43(12):996-999.
[17]	Legrand M, Tolwani A. Anticoagulation strategies in continuous renal replacement therapy[J]. Semin Dial, 2021, 34(6):416-422. doi: 10.1111/sdi.v34.6
[18]	LaMonte MP, Brown PM, Hursting MJ. Alternative parenteral anticoagulation with argatroban,a direct thrombin inhibitor[J]. Expert Rev Cardiovasc Ther, 2005, 3(1):31-41. doi: 10.1586/14779072.3.1.31 pmid: 15723573
[19]	Arepally GM. Heparin-induced thrombocytopenia[J]. Blood, 2017, 129(21):2864-2872. doi: 10.1182/blood-2016-11-709873 pmid: 28416511
[20]	Gameiro J, Jorge S, Lopes JA. Haemodialysis-related-heparin-induced thrombocytopenia:case series and literature review[J]. Nefrología Engl Ed, 2018, 38(5):551-557.
[21]	Koster A, Ljajikj E, Faraoni D. Traditional and non-traditional anticoagulation management during extracorporeal membrane oxygenation[J]. Ann Cardiothorac Surg, 2019, 8(1):129-136. doi: 10.21037/acs
[22]	Schilder L, Nurmohamed SA, Bosch FH, et al. Citrate anticoagulation versus systemic heparinisation in continuous venovenous hemofiltration in critically ill patients with acute kidney injury:a multi-center randomized clinical trial[J]. Crit Care, 2014, 18(4):472. doi: 10.1186/s13054-014-0472-6
[23]	Stucker F, Ponte B, Tataw J, et al. Efficacy and safety of citrate-based anticoagulation compared to heparin in patients with acute kidney injury requiring continuous renal replacement therapy:a randomized controlled trial[J]. Crit Care, 2015, 19(1):91. doi: 10.1186/s13054-015-0822-z
[24]	GB 15982—2012医院消毒卫生标准[S].
	GB 15982-2012 Hospital Disinfection and Sanitation Standards[S].
[25]	国家卫生和计划生育委员会. 重症监护病房医院感染预防与控制规范WS/T 509:2016[J]. 中国感染控制杂志, 2017, 16(2):191-194.
	National Health and Family Planning Commission. (2016).Regulation for prevention and control of healthcare associated infection in intensive care unit[J]. Chin J Infect Control, 2017, 16(2):191-194.
[26]	WS/T 313-2019医务人员手卫生规范[S/OL]. http://wwww nhc.gov.cn/wjw/s9496/202002/dbd143c44abd4de8b59a235feef7d75e.shtml.
	WS/T 3132019 Hand Hygiene Guidelines for Medical Person-nel[S/OL]. http://wwww nhc.gov.cn/wjw/s9496/202002/dbd143c44abd4de8b59a235feef7d75e.shtml.
[27]	卫生部. 医院隔离技术规范[J]. 中华医院感染学杂志, 2009, 19(13).
	Chinese Medical Association Extracorporeal Life Support Professional Committee. (2018). Technical specification for hospital isolation[J]. Chin J Nosocomioly,2009, 19(13).
[28]	Miyatake Y, Makino S, Kubota K, et al. Association between intra-circuit activated clotting time and incidence of bleeding complications during continuous renal replacement therapy using nafamostat mesilate:a retrospective pilot observational study[J]. Kobe J Med Sci, 2017, 63(1):E30-E36.
[29]	Akhoundi A, Singh B, Vela M, et al. Incidence of adverse events during continuous renal replacement therapy[J]. Blood Purif, 2015, 39(4):333-339. doi: 10.1159/000380903
[30]	刘大为, 杨荣利, 陈秀凯. 重症血液净化[M]. 北京: 人民卫生出版社, 2017.
	Liu DW, Yang RL, Chen XK. CCBP critical care blood purification[M]. Beijing: People’s Medical Publishing House, 2017.
[31]	陈香梅. 血液净化标准操作规程[M]. 北京: 人民卫生出版社, 2021.
	Chen XM. Standard operating procedures for blood purificatio. People’s Medical Publishing House, 2021.
[32]	Liu SY, Xu SY, Yin L, et al. Management of regional citrate anticoagulation for continuous renal replacement therapy:guideline recommendations from Chinese emergency medical doctor consensus[J]. Mil Med Res, 2023, 10(1):23.
[33]	王庆云, 肖素飞, 卢嫦清, 等. 连续性肾脏替代治疗嵌入体外膜肺氧合管路连接方式的研究进展[J]. 中华护理杂志, 2022, 57(7):811-816. doi: 10.3761/j.issn.0254-1769.2022.07.007
	Wang QY, Xiao SF, Lu CQ, et al. Continuous renal replacement therapy embedded in extracorporeal membrane oxygenation:a review[J]. Chin J Nurs, 2022, 57(7):811-816.
[34]	唐晓, 孙兵. 体外膜肺氧合抗凝管理进展[J]. 内科急危重症杂志, 2022, 28(5):357-360.
	Tang X, Sun B. Progresses in anticoagulation management of extracorporeal membrane oxygenation[J]. J Intern Intensive Med, 2022, 28(5):357-360.
[35]	李镇洲, 万建新. 局部枸橼酸抗凝在连续性肾脏替代治疗中的应用要点[J]. 中国血液净化, 2021, 20(12):797-800.
	Li ZZ, Wan JX. Application of local citrate anticoagulation in continuous renal replacement therapy[J]. Chin J Blood Purif, 2021, 20(12):797-800.

Expert consensus on anticoagulation nursing operations for continuous renal replacement therapy in adult critical care patients

RichHTML

PDF (PC)

Supplement

Knowledge

Abstract

Cite this article

share this article

Figures/Tables 2

References 35

Related Articles 15

Recommended Articles

Metrics

Comments

[1]	JIN Yufeng, XUE Yulong, SHEN Cunyi, XING Binyu, HE Dong. Application and management of nafamostat mesilate anticoagulation in continuous renal replacement therapy：a best evidence summary [J]. Chinese Journal of Emergency and Critical Care Nursing, 2026, 7(8): 1009-1016.
[2]	XU Yaling, YUAN Jing, ZHANG Yujiao, WANG Weina, YING Jinping. Nursing care for an elderly patient undergoing lung transplantation complicated with rhabdomyolysis and receiving continuous renal replacement therapy [J]. Chinese Journal of Emergency and Critical Care Nursing, 2026, 7(3): 322-324.
[3]	Internal Medicine Nursing Professional Committee of the Chinese Nursing Association, Nursing Professional Committee of the National Cardiovascular Disease Expert Committee, （Writing Committee：TIAN Qing, PANG Ran, ZHAO Rui, WANG Mengwei, XIE Yunyi, LIU Yuwen, WANG Fei, HA Shusong, WANG Hanle. Expert consensus on emergency nursing practice for patients with acute aortic dissection [J]. Chinese Journal of Emergency and Critical Care Nursing, 2026, 7(1): 70-76.
[4]	PENG Li, XU Cuirong, FENG Bo, YAO Yuanyuan, XING Xingmin, YU Lin. Construction and applicability analysis of management scheme for preventing unexpected interruption of continuous renal replacement therapy in ICU patients [J]. Chinese Journal of Emergency and Critical Care Nursing, 2025, 6(9): 1036-1041.
[5]	LIU Yuting, QI Mengying, MENG Siya, WANG Binghan, WANG Qiaosha, HE Guilan. Construction and application effects of an analgesia and sedation management program for adult patients undergoing extracorporeal membrane oxygenation therapy [J]. Chinese Journal of Emergency and Critical Care Nursing, 2025, 6(8): 901-907.
[6]	Surgical Nursing Professional Committee of Chinese Nursing Association , Nursing Department/Neurosurgery/Vascular Surgery/Critical Care Medicine，The First Affiliated Hospital of Chongqing Medical University , Department of Nursing，Tongji Hospital，Tongji Medical College，Huazhong University of Science and Technology , （Writing Committee：LIU Liping，ZHANG Ping，ZHU Hua，WU Qiansheng，ZHANG Chuanlin，LIU Jiali，QIN Jingwen，LIU Meiyan） . Expert consensus on the prevention and nursing of postoperative delirium in adults [J]. Chinese Journal of Emergency and Critical Care Nursing, 2025, 6(7): 837-842.
[7]	LU Hailin, WANG Huihong, HUA Jianing, FANG Tingting, LIU Yiran, TANG Jue, CHENG Haoran, GU Danfeng. Evidence summary for the nursing of the conservative oxygen therapy in adult critically ill patients [J]. Chinese Journal of Emergency and Critical Care Nursing, 2025, 6(6): 751-757.
[8]	CHEN Lihua, SHENG Qingqing, HUANG Yao, WANG Xinning, TAN Yufeng, HE Tingting, ZHANG Shuqin. Summary of best evidence on monitoring and management for hypothermia in patients with continuous renal replacement therapy [J]. Chinese Journal of Emergency and Critical Care Nursing, 2025, 6(5): 610-615.
[9]	LU Jiao, SI Xia, ZHANG Yinghui, ZHANG Liyu, WANG Cailing. A scoping review of risk predictive models for extracorporeal circulation coagulation in patients undergoing continuous renal replacement therapy [J]. Chinese Journal of Emergency and Critical Care Nursing, 2025, 6(11): 1386-1393.
[10]	Beijing Extracorporeal Life Support Quality Control and Improvement Center/Center for Cardiac Intensive Care of Beijing Anzhen Hospital Capital Medical University. Consensus on nursing care for adult extracorporeal membrane oxygenation circulatory assistance [J]. Chinese Journal of Emergency and Critical Care Nursing, 2025, 6(1): 70-75.
[11]	National Clinical Research Center for Child Health/Nursing Department, Children‘s Hospital, Zhejiang University School of Medicine, Nursing Department, Children‘s Hospital, Capital Medical University, Nursing Department, Children‘s Hospital of Fudan University, PICU, Shanghai Children‘s Medical Center, Shanghai Jiao Tong University School of Medicine, PICU, Children‘s Hospital, Chongqing Medical University, Emergency Department, Guangzhou Women, Children's Medical Center, Emergency Department, Children‘s Hospital of Soochow University, Nursing Department, Ningbo Women, Children‘s Hospital（Writing committee：ZHU Jihua, LIU Lili, HU Jing, CHEN Wenqiong, TAO Yi, YU Biyan, YU Zhen, CEN Huiping, CHEN Yaru, LI Shuaini）. Expert consensus on safe interhospital transport of critically ill children [J]. Chinese Journal of Emergency and Critical Care Nursing, 2024, 5(9): 825-829.
[12]	ZHANG Qiuyang, YU Shaoyun, PANG Xiangying, XIA Hua, ZHAO Xuehong. Research progress on health-related quality of life in adult survivors of extracorporeal membrane oxygenation [J]. Chinese Journal of Emergency and Critical Care Nursing, 2024, 5(8): 764-768.
[13]	LI Lili, HUA Jiali, ZHANG Xinyin, DONG Yongze, SONG Yuying, CHEN Juanying, YAO Huiping. Summary of the best evidence for the prevention and management of central venous catheter-related thrombosis in patients undergoing continuous renal replacement therapy [J]. Chinese Journal of Emergency and Critical Care Nursing, 2024, 5(5): 466-473.
[14]	SU Xin, GAO Yufang, LIU Dun. Latent profile analysis and factors influencing early post-traumatic growth in young and middle-aged accidental trauma patients [J]. Chinese Journal of Emergency and Critical Care Nursing, 2024, 5(2): 115-120.
[15]	DAI Zhenjuan, XU Shenting, ZHOU Jianying, CHEN Jianqin, XUE Fangying, WANG Xuemin, SUN Shifan. Study on the stability management of calcium ion levels in patients undergoing continuous renal replacement therapy with regional citrate anticoagulation [J]. Chinese Journal of Emergency and Critical Care Nursing, 2024, 5(2): 159-164.