Description

Prismocitrate 18/0, developed by Baxter Gambro, is a specialized citrate-buffered solution tailored for regional citrate anticoagulation (RCA) in continuous renal replacement therapy (CRRT). This formulation is particularly suited for continuous venovenous hemofiltration (CVVH), offering compatibility with various blood flow rates and weight-based dosing regimens.

Key Features

• Calcium-Free Composition: Prismocitrate 18/0 is designed as a calcium-free solution, effectively serving as a replacement fluid during CRRT with RCA. This characteristic helps prevent antagonism of the anticoagulation effect, ensuring optimal performance.

• Sodium Concentration: The solution maintains a physiological sodium concentration, mitigating the risk of hypernatremia and contributing to acid-base balance as a buffer.

• Metabolic Management: Even at high infusion rates, it minimizes citrate-related metabolic complications, enhancing safety and efficacy.

Benefits

• Workflow Efficiency: The design of Prismocitrate 18/0 aims to streamline workflow efficiencies for both pharmacy and nursing staff. It is used as a predilution solution in CVVH, providing necessary anticoagulation and buffer balance.

• Higher Citrate Concentration: Compared to other formulations like Prismocitrate 10/2, its higher citrate concentration may reduce the need for additional bicarbonate infusion, simplifying treatment protocols.

Formulation Details

• Sodium: 140 mmol/L
• Chloride: 86 mmol/L
• Citrate: 18 mmol/L
• Potassium, Calcium, Magnesium, Bicarbonate, Phosphate: 0 mmol/L

Clinical Application

Prismocitrate 18/0 is often used alongside phosphate-containing replacement solutions, such as Phoxilium, to manage electrolyte imbalances without requiring separate bicarbonate infusion. Clinical protocols highlight a median circuit lifetime of approximately 44 hours, with noted simplicity of use and a low incidence of metabolic disorders.

Safety Profile

• Electrolyte Management: The most common electrolyte disturbance observed is hypomagnesemia, which may necessitate intravenous magnesium replacement.

• Administration Safety: The solution is regarded as safe and straightforward to administer in critically ill patients, with no reported cases of citrate accumulation or toxicity. The total calcium to ionized calcium ratio remains within safe limits when used according to guidelines.

Intended Use

Prismocitrate 18/0 is intended for use as a replacement fluid in CRRT with regional citrate anticoagulation, particularly beneficial for critically ill patients. For comprehensive safety and efficacy, users are advised to follow the Instructions for Use provided with the product.