(精编)【持续性肾脏替代治疗CRRT英文精品课件】Continuous Renal Replacement Therapy.pptVIP

This picture depicts a membrane that has large pore size. As you can see from this picture we have a membrane with large pores. Again, we will say the pink molecule represent Urea molecules, and the green molecules represent a cytokine molecules. The Urea easily passes through the large pores, and the Cytokines also move across the membrane therefore they are removed from the blood. Back to the basic CRRT transport principles: the combination of diffusion and convection allow small molecules to easily pass through the membrane, and middle and large molecules to be driven across the filter by convection. The semi-permeable membrane allows removal of solutes with a molecular weight of up to 50,000 Daltons. Keep in mind that anything that is protein-bound will not be cleared. Now that you have an understanding of molecular size and membrane porosity let me introduce to you sieving co-efficient. Sieving coefficient is defined as the ability of a substance to pass through a membrane from the blood compartment of the hemofilter to the filter side of the hemofilter. Solutes with a sieving coefficient of 1 means 100% movement of that solute moves across the membrane, but a coefficient of 0 the solute is unable to pass through the membrane at all. For example, the sieving coefficient of potassium is 1, meaning that 100% of it will cross the membrane. The sieving coefficient of Albumin is 0, meaning it is unable to move across the membrane because of its large size. . A patient will need a veno-venous double lumen catheter or two single lumen venous hemodialysis catheter. One side of the lumen will deliver blood from the patient to the filter, and the other lumen will return the blood back from the filter to the patient. There are three access locations that are used some may be preferred over others. Internal jugular vein is the primary choice due to the simplicity of catheter insertion. Femoral vein is a great access when a patient is immobilized, and is also co