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“Put them on the Filter”

“Put them on the Filter”. Renal Replacement Therapy in ITU Susanne Young Aug 04. content. Indications for RRT Dialysis vs Haemofiltration recap Variations in RRT What we need to know!. Indications for RRT. Uraemia Acidosis Fluid overload Hyperkalaemia Pericarditis.

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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?

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