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“Put them on the Filter”

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Presentation on theme: "“Put them on the Filter”"— Presentation transcript:

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

4 DIALYSIS V FILTRATION Diffusion based solute removal
Convection based water (& sol) rem Int. 4-6 hrs. Rapid rate sol/fl loss “go slow dialysis” continuous Usually av access. BP driven (7l/d) VV needs extra cor blood pump (16l/d) Dialysate flows countercurrent <5000 Da get dragged across

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



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 iu/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: ml/h, (higher in SCUF) around 100ml/h ballpark AS PER FLUID BALANCE Replacement fluid flow rate: ml/h, (lower in HD mode) Blood flow ml/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?

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