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“Put them on the Filter”

“Put them on the Filter”

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“Put them on the Filter”

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  1. “Put them on the Filter” Renal Replacement Therapy in ITU Susanne Young Aug 04

  2. content • Indications for RRT • Dialysis vs Haemofiltration recap • Variations in RRT • What we need to know!

  3. Indications for RRT • Uraemia • Acidosis • Fluid overload • Hyperkalaemia • Pericarditis

  4. DIALYSIS V FILTRATION

  5. DIALYSIS • Aggressive removal of small solutes: Ur, Crn, K, move down concn gradient • Ca, HCO3 moves from dialysate to blood • Fluid removal slower but reduction in solute concentration faster • Replacement fluid not usually given • More risk arterial embolisation

  6. FILTRATION • Removal of fluid • Filtration itself removes small solutes in roughly the same concentrations as plasma • Removes large solutes • High flow rates would cause hypovolaemia • So, admin of (solute poor) substitution fluid will reduce solute concentration by dilution.

  7. Types of RRT • SCUF- no replacement fluid, dehydrating • CVVH- replacement solution • CVVHD- replacement and dialysate soln. • CVVHDF • IAVHD

  8. SCUF

  9. CVVH

  10. When are you checking the coag? • HEPARIN • lock the lines at insertion (5000iu/ml) or when not in use. • ?Heparin bolus- yes unless contraindicated 50iu/kg • Aim for APR 1.5x normal only. Start at 800-10000iu/hr (1000iu/ml ALWAYS) • Check at 4hrs then daily

  11. How much fluid do you want off • FLUID REMOVAL in CVVH • Patient Fluid removal rate: 10-1000ml/h, (higher in SCUF) around 100ml/h ballpark AS PER FLUID BALANCE • Replacement fluid flow rate: 100-4500ml/h, (lower in HD mode) • Blood flow 10-180ml/min (120 ususal) • Check U&E at 4hrs

  12. What bags do you want me to use • Standard bag composition: • Lactate free if Met Acidosis • More K+ if hypokalaemic 2-4mmol/h. • Now could you fill out the prescription?