【持续性肾脏替代治疗CRRT英文精品课件】Practical Considerations for CRRT.pptVIP

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2018-06-06 发布于浙江
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【持续性肾脏替代治疗CRRT英文精品课件】Practical Considerations for CRRT.ppt

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【持续性肾脏替代治疗CRRT英文精品课件】Practical Considerations for CRRT

Practical Considerations for CRRT Advantages of CRRT SLOW: Hemodynamically unstable patients may not tolerate the rapid ultrafiltration of intermittent hemodialysis CONTINUOUS: Can help preserve metabolic stability in critically ill patients; can maintain fluid balance for oliguric patients who require high daily input (IV medications, parenteral nutrition) CVVH SYSTEM CVVHD SYSTEM Success with CRRT Access Equipment Tubing/filter Prime Anticoagulation Staffing Access-What Works? Hemodialysis /Pheresis Line Shortest, fattest catheter possible (highest flows with least resistance) May need two single lumen lines Leg position-be creative Tape on the skin-may need to get creative CRRT Machines: Current Generation Tubing and Equipment Tubing volume ranges from 44-110 ml Filter volume ranges from 28 – 83 ml Hotline volume 18.5 ml Blood volume of patient (~70 ml/kg) PRISMA – 108 ml BM-25 -Smallest filter + tubing + hotline = 90.5 ml Extracorporeal Volume Blood volume in extracorporeal circuit is very large compared to a small infant or child Patients require a blood prime if the circuit 10% of their blood volume Blood Prime Whole blood PRBC + Albumin 5% PRBC + NS PRBC + FFP Larger patients Albumin 5% AN-69 filter requires special considerations Bradykinin Release Syndrome(Brophy et al Am J Kidney Dis. 2001 Jul;38(1):173-8 ) What is the link Blood bank blood has ICa of 0.04 mmol/l K+ of 40-60 mEq/l pH of 6.4 Reaction can be mitigated by buffering the blood and giving IV calcium at initiation Buffered System ECMO circuits are commonly primed with a cocktail to correct the pH, Hct, and K of banked blood Addition of THAM calcium chloride Heparin Sterile Water Sodium bicarb Bypass System Transfuse the PRBC post-filter directly into the patient The patient is then connected to the circuit Using the same rate for priming on and infusing the PRBC (mixed with NS or Alb) Thus the patient’s blood can be used as a “bradykinin filter” (Brophy,et al 2001AJKD) Anticoagul