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

Objective:To determine the adequate site of activated coagulation time (ACT ) measurement during continuous haemodiafiltration (CHDF) using nafamostat mesilate. Design: Prospective, consecutive, clinical study. Setting: An intensive care unit of a general hospital. Patients: Ten patients with acute organ failure including kidney, lung and liver, caused by sepsis after major surgery. Interventions: A CHDF circuit with a haemofilter made of polymethylmethacry late membrane was primed with 50 mg nafamostat in 500 ml saline, and was st arted 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 f luid was set. Measurements and results: The circuit pressure at the inlet and outlet of t he circuit were monitored, and ACT was measured every 2 h at the site of na famostat 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 val ue of ACT. The circuit pressure did not change significantly. The ACT did n ot 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. Conclusions: The ACT value at the inlet of the circuit may be adequate to m onitor anticoagulation during CHDF using nafamostat.