Crrt continue Renal Replacement Therapy cvvh cvvhd
tarix 21.04.2017 ölçüsü 445 b. #14824
Indications In critically ill patients with renal failure and hemodynaemic instability For patients in whom continuous removal of volume or toxic substance is desirable ( as in septic shock , AMI , severe GI bleeding ,ARDS or condition with or at risk for cerebral edema ….) Procedure共同處 Driving force : external pump Circuit : Venovenous Dialysis solutions :一般使用1.5% PD solution Replacement fluid : several types of replacement fluid can be used , depending on patient requirements ,一般使用 pre-dilution 方式. Anti-coagulation 的方式 STANDARD HEPARIN TYPICAL REGIMEN IN CRRT :Priming of the circuit ( 5000 IU / L ) Initial Heparin Bolus : 5 - 8 IU / kg Infuse Heparin at : 5 to 12 IU / kg / hr ACT on post filter : Adjust heparin rate to keep ACT between 1.5 & 2.0 times STANDARD HEPARIN ADVANTAGES Easy to perform Useful method Inexpensive LOW MOLECULAR WEIGHT (LMW) HEPARIN TYPICAL REGIMEN IN CRRT : Priming of the circuit : 20 mg in 1 L Maintenance dose : 10 to 40 mg q6 hrs Monitor anti- factor Xa (aXa) units . Adjust between 0.1 and 0.4 µ/ml LOW MOLECULAR WEIGHT (LMW) HEPARIN ADVANTAGES Decreased Risk Regional Citrate Anticoagulation TYPICAL REGIMEN : Citrate anticoagulation is always regional Citrate infusion (4%) at 170 ml/hr initially Special Dialysate at 1 liter/hr ( Na+ 117 , K+ 4 , Mg++ 1.5 , Cl- 121.5 , dextrose 0.5- 2.5% , no Ca++ , no base ) CaCL2 (0.75%) by central I.V at 40-60 ml/hr, Maintain ionized Ca++ at 0.96- 1.20 mmol/L Citrate ADVANTAGES : No Bleeding No Thrombocytopenia Improved Filter Life and Efficacy Heparin- free methos Normal saline flush 1. Severe liver disease 2. Acitve or recent bleeding 3. Heparine-induced thrombocytopenia 4. Post-op patients CVVH配置簡圖
CVVH order Prepare Heparin 2cc + N/S 3cc, then inject 1.6cc into each femoral cath. For AK priming: (GAMBRO, Polyarylethersulfone, 6S) *1st N/S 1000cc. *2nd Heparin 2,500U. *3rd N/S 500cc. *Prepare Heparin 25,000U + N/S 500cc IVD 10cc/hr with pump to keep aPPT 1.5-2 and adjust as followed: aPPT bolus hold dose(cc/hr) <1.0 2000U - +4 1.0-1.5 - - +2 1.5-2.0 - - - 2.0-2.5 - 30min -2 >2.5 - 60min -4 CVVH order If non-heparin , N/S 200cc q ½ hr to rinse the AK 1st bottle N/S 500cc + Sinca 1amp 2nd bottle N/S 500cc + 10% MgSO4 4cc 3rd bottle N/S 500cc 4th bottle D5W 500cc + NaHCO3 5amp Warm dialysate to 37C Record I/O and BP q1hr UF target I-O ( ) cc/hr Check BUN ,Crea,Na,K,Cl,aPPT q6hr for 1 day & then q8hr. Check Ca,P,Mg qd. CVVHD配置簡圖 CVVHD Continuous Veno-Venous Hemodialysis CVVHD order Prepare Heparin 2cc + N/S 3cc, then inject 1.6cc into each femoral cath. For AK priming: (GAMBRO, Polyarylethersulfone, 6S) *1st N/S 1000cc. *2nd Heparin 2,500U. *3rd N/S 500cc. *Prepare Heparin 25,000U + N/S 500cc IVD 10cc/hr with pump to keep aPPT 1.5-2 and adjust as followed: aPPT bolus hold dose(cc/hr) <1.0 2000U - +4 1.0-1.5 - - +2 1.5-2.0 - - - 2.0-2.5 - 30min -2 >2.5 - 60min -4 CVVHD order If non-heparin , N/S 200cc q ½ hr to rinse the AK Warm dialysate to 37C Record I/O and BP q1hr UF target I-O ( ) cc/hr Check BUN,Crea,Na,K,Cl,aPPT q6hr for 1 day & then q8hr. Check Ca,P,Mg qd. CVVHDF配置簡圖 CVVHDF Continuous Veno-Venous Hemodiafiltration CVVHDF order Prepare Heparin 2cc + N/S 3cc, then inject 1.6cc into each femoral cath. For AK priming: (GAMBRO, Polyarylethersulfone, 6S) *1st N/S 1000cc. *2nd Heparin 2,500U. *3rd N/S 500cc. *Prepare Heparin 25,000U + N/S 500cc IVD 10cc/hr with pump to keep aPPT 1.5-2 and adjust as followed: aPPT bolus hold dose(cc/hr) <1.0 2000U - +4 1.0-1.5 - - +2 1.5-2.0 - - - 2.0-2.5 - 30min -2 >2.5 - 60min -4 CVVHDF order If non-heparin , N/S 200cc q ½ hr to rinse the AK Predilution run 500cc/hr alternately as followed via artery end 1st bottle N/S 500cc + Sinca 1amp 2nd bottle N/S 500cc + 10% MgSO4 4cc 3rd bottle N/S 500cc 4th bottle D5W 500cc + NaHCO3 5amp 1.5% PD solution 500cc/hr run as dailysate Warm predilution and dialysate to 37C Record I/O and BP q1hr UF target I-O ( ) cc/hr Check BUN,Crea,Na,K,Cl,aPPT q6hr for 1 day & then q8hr. Check Ca,P,Mg qd. Dostları ilə paylaş:
