【持续性肾脏替代治疗crrt英文精品课件】practical considerations for crrt

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1、PracticalConsiderationsforCRRTHelenCurrierRN,BSN,CNNNancyMcAfeeRN,BSN,CNNAdvantagesofCRRTSLOW:HemodynamicallyunstablepatientsmaynottoleratetherapidultrafiltrationofintermittenthemodialysisCONTINUOUS:Canhelppreservemetabolicstabilityincriticallyillpatients;canm

2、aintainfluidbalanceforoliguricpatientswhorequirehighdailyinput(IVmedications,parenteralnutrition)CVVHSYSTEMVenouschamberReplacementfluidHeparinDrainagebag/UFFromthepatientTothepatientRollerpumpHemofilterIVpumpAirdetectorbm14rollerpumpRollerpumpVenouschamberRepl

3、acementfluidHeparinDrainagebag/UFFromthepatientTothepatientRollerPumpHemofilterIVpumpDialysateIVpumpAirdetectorbm14rollerpumpRollerPumpCVVHDSYSTEMSuccesswithCRRTAccessEquipmentTubing/filterPrimeAnticoagulationStaffingAccess-WhatWorks?Hemodialysis/PheresisLineSh

4、ortest,fattestcatheterpossible(highestflowswithleastresistance)MayneedtwosinglelumenlinesLegposition-becreativeTapeontheskin-mayneedtogetcreativeBloodPumpSystemsforCRRTCRRTMachines:CurrentGenerationTubingandEquipmentTubingvolumerangesfrom44-110mlFiltervolumera

5、ngesfrom28–83mlHotlinevolume18.5mlBloodvolumeofpatient(~70ml/kg)PRISMA–108mlBM-25-Smallestfilter+tubing+hotline=90.5mlExtracorporealVolumeBloodvolumeinextracorporealcircuitisverylargecomparedtoasmallinfantorchildPatientsrequireabloodprimeifthecircuit>10%oftheir

6、bloodvolumeBloodPrimeWholebloodPRBC+Albumin5%PRBC+NSPRBC+FFPLargerpatientsAlbumin5%AN-69filterrequiresspecialconsiderationsWhatisthelinkBloodbankbloodhasICaof0.04mmol/lK+of40-60mEq/lpHof6.4ReactioncanbemitigatedbybufferingthebloodandgivingIVcalciumatinitiationB

7、radykininReleaseSyndrome(BrophyetalAmJKidneyDis.2001Jul;38(1):173-8)BufferedSystemECMOcircuitsarecommonlyprimedwithacocktailtocorrectthepH,Hct,andKofbankedbloodAdditionofTHAMcalciumchlorideHeparinSterileWaterSodiumbicarbBypassSystemTransfusethePRBCpost-filterdi

8、rectlyintothepatientThepatientisthenconnectedtothecircuitUsingthesamerateforprimingonandinfusingthePRBC(mixedwithNSorAlb)Thusthepatient’sbloodcanbeusedasa“bradykininfilter”(