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A microbiological survey of bicarbonate-based replacement circuits in continuous veno-venous hemofiltration

Lookup NU author(s): Dr Andrew Kilner, Dr Katherine Orr, Dr Suren Kanagasundaram


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Objective: The potential for clinically significant transfer of pyrogen-inducing material in dialysate and substitution fluids is well recognized in the setting of chronic hemodialysis and hemodiafiltration and has led to the establishment of strict standards for microbiological purity. Preliminary evidence has indicated the potential for fluid contamination in continuous renal replacement therapy, and although the scale of the problem in contemporary, industry-standard equipment is unclear. We aimed to define the microbial integrity of modern continuous veno-venous hemofiltration (CVVH) replacement fluid circuitry. Design: Twenty-four CVVH replacement fluid circuits (mean lifespan, 34.2 hours; range, 4-86) were studied at completion of therapy. Setting: The integrated critical care unit and cardiothoracic intensive care unit of the Freeman Hospital, Newcastle upon Tyne, United Kingdom, between January and August 2007. Subjects. Patents with renal failure receiving treatment with CVVH. Interventions. Nil. Measurements: Culture and endotoxin assays of replacement fluid, culture of endoluminal swabs, and electron microscopy of harvested tubing. Main Results: Of the 24 replacement fluid cultures, nine (mean lifespan 32.8 hours, range 5-79) breached European Pharmacopoeia standards for ultrapure water (

Publication metadata

Author(s): Moore I, Bhat R, Hoenich NA, Kilner AJ, Prabhu M, Orr KE, Kanagasundaram NS

Publication type: Article

Publication status: Published

Journal: Critical Care Medicine

Year: 2009

Volume: 37

Issue: 2

Pages: 496-500

ISSN (print): 0090-3493

ISSN (electronic): 1530-0293

Publisher: Lippincott Williams & Wilkins


DOI: 10.1097/CCM.0b013e3181957987


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