Regional Citrate Anticoagulation (RCA)

Regional Citrate Anticoagulation (RCA) : A Guide

Regional Citrate Anticoagulation (RCA) is a method of anticoagulation therapy used to maintain life-critical veno-venous extracorporeal membrane oxygenation (ECMO) in medical intensive care units (ICUs) and neonatal intensive care units (NICUs). It is frequently used to treat patients with severe cardiac or respiratory failure, as well as for those undergoing major surgery or organ transplants. The purpose of regional citrate anticoagulation is to prevent clot formation, protect from blood clotting, and reduce the risk of embolism.

How Does Regional Citrate Anticoagulation (RCA) Work?

RCA works by replacing some of the patient’s original plasma with citrate-enriched plasma. Citrate is an organic compound that binds calcium and prevents clotting factors, such as thrombin, from forming clots. In this way, regional citrate anticoagulation prevents clot formation and embolism.

The administration of citrate-enriched plasma is typically done through the patient’s arterial line. This involves introducing a syringe filled with citrate solution directly into the artery. The citrate is then infused into the patient’s bloodstream in a controlled manner, until the desired concentration is reached. The citrate-enriched plasma is then removed, with fresh plasma being added in its place.

Benefits of Regional Citrate Anticoagulation (RCA)

  • Reduces the risk of embolism.
  • Reduces the risk of blood clot formation.
  • Minimizes the need for additional anticoagulants.
  • Reduces the need for platelets.
  • Can be used for extended periods of time.
  • Reduces the risk of hemorrhage and vascular damage.
  • Increases patient safety.

Limitations of Regional Citrate Anticoagulation (RCA)

While regional citrate anticoagulation offers many benefits, it should be noted that the procedure does have some potential limitations. For example, the process can be time-consuming and may require frequent monitoring of the patient’s plasma calcium levels. Additionally, the administration of citrate solution can lead to excessive serum levels of calcium in the patient, which can lead to a variety of side effects. Finally, added costs can be incurred due to the need for additional anticoagulants and platelet transfusions.

Conclusion

Overall, regional citrate anticoagulation is a safe and effective method of preventing blood clotting and embolism. It has been used in medical ICUs and NICUs for many years, and the procedure has proven to be very successful in reducing clot formation and increasing patient safety. However, it is important to consider the potential limitations before implementing the technique and to monitor the patient’s calcium levels frequently.

  • Inborn error in primary bile acid synthesis
  • Mild-to-moderate COVID-19
  • Pustular Psoriasis (PP)
  • Neoplastic lesion
  • Upper Respiratory Tract Infection caused by susceptible bacteria
  • Gas Gangrene
  • Arsenic Poisoning
  • Uncomplicated veins 1 to 3 mm in diameter reticular veins
  • Severe Systemic candidiasis
  • Major Depressive Disorder (MDD)
  • Parainfluenza Tests
  • Creatinine urine test
  • Anti-smooth muscle antibody
  • IGF-1 (Insulin-like Growth Factor 1) Test
  • Synovial Fluid Analysis
  • Allergy testing - skin
  • MPV Blood Test
  • Ureteral retrograde brush biopsy
  • Parathyroid hormone-related protein blood test
  • Ultrasound pregnancy