CRRT solutions. Benan Bayrakci , 2014. CRRT deliver y. CVVH is convective , use replasment fluid ( lood side of the filter ) CVVHD is diffusive , use dialysate fluid ( opposite side of the filter ) T here are no convincing clinical data to support either CVVH or CVVHD
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Benan Bayrakci, 2014
- Thecomplications of compounding include increased costand a shortershelf life (usually 30 days).
- K, P, Mg and even bicarbcan be addedas needed but, carriestherisqueforpharmacy errors and may increase costs.
- Whether replacement fluid or dialysateis utilized, the fluid should be ultrapure and sterile.
- Eachtime an additive is injected, this isassociated with a chance of human error; contamination; wrongdose; wrong syringe,wrong vialetc.
- The safest approach. Lessexpensive and have longer shelf life.
- Availablefrom multiple manufacturers, generally 3 l and 5 l bagswith a discrete number of fluid compositions.
- The most common concentrations of these solutes are equal to normal plasmalevels
Barletta et al, PediatrNephrol. 21(6):842-5, 2006 Jun
becauseof therisque of hyperglycemiaandmetabolicacidosis
Theaddition of phosphate to the CRRT fluids at concentrationsof up to 7.7 mg/dL does not cause problems with precipitationor instability of the mixture.
Bicarb-buffered replacement fluids can improve acid-base status and reduce cardiovascularevents better than lactate fluids
Dialysate solutions containing bicarbonate have low compatibility with calcium. Ifcalcium is added to a bag containing bicarbonate, calcium carbonateproduces , which could precipitate out of solution and clog the filter.
Can be added in dialysateto remove proteinbound medications in the setting of intoxication as well as substancessuchbilirubin