These are alternatives to dialysis that require a pressurised, purified water supply, more expensive equipment and operator expertise, and a greater risk of haemodynamic instability due to rapid fluid and osmotic shifts. Haemo(dia)filtration can be arteriovenous, using the patient's blood pressure to drive blood through the haemofilter, or pumped veno-venous. The latter is advantageous in that it is not dependent on the patient's blood pressure and the pump system incorporates alarms and safety features. Veno-venous haemo(dia)filtration is increasingly the technique of choice. Blood is usually drawn and returned via a 10-12Fr double lumen central venous catheter.
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