Would you add regional citrate anticoagulation to a CRRT prescription for a patient on systemic heparin but who experiences recurrent filter clotting?

Depending on the need for CRRT vs PIRRT, if I could, I would go with PIRRT first depending on when the clotting occurs in the treatment. Our typical PIRRT treatment is 40 liters over 8 hours, and we can do that daily if needed (often at night), and it totally controls the chemistries and usually volume. But clearly, some patients need CRRT for volume, acidosis, CV surgeon comfort...

I suppose the real answer is yes for citrate because citrate is by far the gold standard for preventing Circuit c...

I think that would be reasonable, but the key is also to see perhaps why the patient is clotting by looking to see if the system is clotting because of high venous pressures or arterial pressures, or if the TMP starts to increase. High venous pressures would imply that perhaps the catheter may be playing a role as well. Keep in mind that citrate anticoagulation is not indicated in patients with cirrhosis, and can lead to citrate toxicity in those who are cachectic as well (ie, low muscle mass in...