Presentation on theme: "“Put them on the Filter”"— Presentation transcript:
1“Put them on the Filter” Renal Replacement Therapy in ITUSusanne YoungAug 04
2content Indications for RRT Dialysis vs Haemofiltration recap Variations in RRTWhat we need to know!
3Indications for RRT Uraemia Acidosis Fluid overload Hyperkalaemia Pericarditis
4DIALYSIS V FILTRATION Diffusion based solute removal Convection based water (& sol) remInt. 4-6 hrs. Rapidrate sol/fl loss“go slow dialysis”continuousUsually av access.BP driven (7l/d)VV needs extra cor blood pump (16l/d)Dialysate flows countercurrent<5000 Da get dragged across
5DIALYSISAggressive removal of small solutes: Ur, Crn, K, move down concn gradientCa, HCO3 moves from dialysate to bloodFluid removal slower but reduction in solute concentration fasterReplacement fluid not usually givenMore risk arterial embolisation
6FILTRATION Removal of fluid Filtration itself removes small solutes in roughly the same concentrations as plasmaRemoves large solutesHigh flow rates would cause hypovolaemiaSo, admin of (solute poor) substitution fluid will reduce solute concentration by dilution.
7Types of RRT SCUF- no replacement fluid, dehydrating CVVH- replacement solutionCVVHD- replacement and dialysate soln.CVVHDFIAVHD
10When are you checking the coag? HEPARINlock the lines at insertion (5000iu/ml) or when not in use.?Heparin bolus- yes unless contraindicated 50iu/kgAim for APR 1.5x normal only. Start at iu/hr (1000iu/ml ALWAYS)Check at 4hrs then daily
11How much fluid do you want off FLUID REMOVAL in CVVHPatient Fluid removal rate: ml/h, (higher in SCUF) around 100ml/h ballpark AS PER FLUID BALANCEReplacement fluid flow rate: ml/h, (lower in HD mode)Blood flow ml/min (120 ususal)Check U&E at 4hrs
12What bags do you want me to use Standard bag composition:Lactate free if Met AcidosisMore K+ if hypokalaemic 2-4mmol/h.Now could you fill out the prescription?