The Alteco LPS Adsorber can be prepared using the blood purification system’s priming procedure, or through manual rinsing and priming.
When to start treatment
For best treatment results, the Alteco LPS Adsorber should be used as early as possible in hemoperfusion (HP), before acute kidney injury (AKI) escalates and the need for continuous renal replacement therapy (CRRT) arises. Start treatment when the patient shows signs of imminent clinical deterioration, meaning:
- Urine production is decreasing (acute kidney failure approaching)
- Mean arterial pressure (MAP) ~ 65 mmHg
- >2 hours of vasopressor support and patient still unstable
Necessary components and equipment
To run the treatment, the following is needed:
- 1 Alteco LPS Adsorber
- 5000IU high-molecular heparin
- 1 double lumen dialysis catheter of size 12-14F, or a Seldinger catheter
- Blood purification system (meeting the international standard of IEC60601-2-16) for extracorporeal treatment
- 1000ml 0,9% saline solution
- Blood purification system manufacturer’s tubing lines
Follow the IFU:s of the Alteco LPS Adsorber and the blood purification system used.
Rinsing and priming procedure
The Alteco LPS Adsorber can be rinsed and primed automatically when connected to the tubing lines in the blood purification system circuit. The rinsing is important to wash out the glycerin used as a stabilizer in the adsorber.
The priming with 1000 ml of 0.9% saline solution with 5000 IU of heparin added is important to prevent clotting in the system during treatment.
Always follow the instructions for use (IFU) for all equipment used.
Heparin should be used during priming and as a bolus dose in the system at treatment start. The anticoagulant dose during the treatment is prescribed by the responsible physician. If Activated Clotting Time (ACT) is measured, it should be kept >180s during the treatment (however, it is normally not measured due to the short treatment time).
Access and blood flow rate
A double lumen dialysis catheter of size 12-14F is required to obtain sufficient blood flow rate of 150 ± 50 ml/min. A femoral Seldinger catheter can also be used.
The recommended flow when using the Alteco LPS Adsorber is 150 ± 50ml/min (minimum 100ml/min and maximum 200ml/min). Note: using a lower blood flow rate may increase the risk of clotting. Using a higher blood flow rate may increase the pressure in the extracorporeal circuit and cause the blood pump to stop, interfering with the treatment.
The Alteco LPS Adsorber is used for extracorporeal endotoxin removal, stand-alone or in combination with a dialysis membrane. The Alteco LPS Adsorber can be used with compatible systems for blood purification (IEC60601-2-16). Refer to the blood purification system IFU.
Hemoperfusion (HP), stand-alone
The recommended treatment modality for the Alteco LPS Adsorber is stand alone in HP mode.
Continuous Renal Replacement Therapy (CRRT), in combination with dialyzer
To treat patients in combination mode, the Alteco LPS Adsorber should be incorporated into the circuit before/upstream from the dialysis filter.
The treatment time in HP mode is 2-6 hours at the recommended blood flow rate (150ml/min).
Note: the blood flow rate affects the treatment time. A lower blood flow rate means a smaller blood volume will be treated, compared to using a medium to high blood flow rate which means a larger blood volume will be treated in the same amount of time.
Discontinue treatment when hemodynamic stabilization has been achieved.
- Stop the blood pump and connect a 500 ml saline bag for rinse back.
- Start the pump at 100 ml/min and return the blood to the patient.
- Disconnect the patient from the system.
- Dispose the blood lines used with the Alteco LPS Adsorber in regular waste for blood disposal.
The physician in charge can determine the need for repeated treatment(s), based on the patient’s condition and hemodynamic response.