CRRT及其护理原创.pptVIP

* Some solutes that are too large to pass through the pores of the membrane, like certain proteins, may be removed from the blood through the process of adsorption. This simply means that the solutes adhere (stick) to the surface or interior of the membrane. Certain membrane characteristics facilitates the adsorption of these molecules. In CRRT, some of the molecules identified to be beneficially removed in some disease conditions are septic, anti-inflammatory and inflammatory mediators such as IL(Interleukine), TNF (Tumor Necrose Factor). CRRT acronyms…. Read slide. As this slide shows, the circuit for SCUF is a simple one. Blood enters the extracorporeal circuit through an access line, passes through the hemofilter, and returns to the patient circulation via the return line. As the blood passes through the filter, ultrafiltration takes place and effluent collects in the effluent bag. Effluent is any fluid that exits the hemofilter and is delivered to a waste bag. Pumps control blood flow and fluid removal rates. This schematic represents a CVVH circuit. As I stated earlier, note that the replacement fluids (indicated by the dotted lines) can be delivered either pre or post filter. In the past replacement fluids were used to control patient’s fluid volume. No equipment was available to provide precise volume control and it was the nurse’s responsibility to calculate total patient intake and output every hour and compare that to the MD’s prescription. Invariably the doctor’s prescribed fluid removal and the actual volume removed were not equal, requiring either the addition of fluid to the patient or trying not to increase fluid removal for the next hour. More often than not, “catch up” was played and this volume infused was referred to as the replacement fluid. With the advent of precise control systems, integrated pumps are used to take the mystery out of fluid management. Solute removal is accomplished by convection. Note that the effluent bag not o