Wales Critical Care & Trauma Network (North) CITRATE GUIDELINES (Approved May 2015)
|
|
- Esther Harrington
- 5 years ago
- Views:
Transcription
1 Wales Critical Care & Trauma Network (North) CITRATE GUIDELINES (Approved May 2015) BCU Citrate Guideline v6 Nov 2015 (Approved by CCSC May 15) 1
2 BCU Critical Care Guideline for Renal Replacement Therapy using Citrate Indication Regional anticoagulation in patients receiving CRRT. Contraindications 1. Severe liver impairment. 2. Paracetamol overdose. 3. Metformin toxicity. 4. Patient already receiving systemic anticoagulation. (All relative, discuss with consultant) Before starting treatment 1. Check the daily blood results before the start of treatment: TOTAL CALCIUM (not the corrected value), magnesium and potassium. 2. Check recent arterial blood gas including calcium (PATIENT IONISED CALCIUM). 3. Ensure patent vascular access (able to withdraw blood at rate of 20mLs/6sec). (NB: APTT levels are not required to operate the treatment.) Equipment needed 1 Prismaflex Filter ST bag of 5L PrismoCitrate 18/0 (citrate used as pre-dilution). 1 bag of 5L Prism0cal B22 (dialysate, calcium-free). 1 bag or 5L Prismasol 4 (post-dilution replacement fluid). 2 bags of 0.9% 1000mLs Sodium Chloride (priming solution - no heparin required). 1 CA250 calcium line. 1 50mL Luer lock syringe. 30mmol calcium (as calcium chloride) made up to 50ml with 0.9% saline. Setting up and priming circuit 1. Select New Patient. 2. Input actual body weight. 3. Input haematocrit. This is found on the full blood count. Unlike in treatment with heparin, haematocrit is important. Update the haematocrit value every morning. 4. Choose CVVHDF. 5. Choose Citrate Anticoagulation via Prismaflex Pump. 6. Follow the installation steps on the screen: Install PrismoCitrate 18/0 on the white scale (PBP = pre blood pump). Install Prism0cal B22 on the green scale. (Dialysate). Install Prismasol 4 on the purple scale (Replacement). 7. Install the calcium chloride in the Prismaflex integral syringe pump. 8. Prime the circuit with 2 X 1L of 0.9% Sodium Chloride (as per on screen instructions) BCU Citrate Guideline v6 Nov 2015 (Approved by CCSC May 15) 2
3 Starting Parameters (NB: if this is not the first set for this patient, simply set calcium compensation and citrate at their previous rates) MODE: CVVHDF FLUID REMOVAL: as advised by doctor CITRATE DOSE: 3 mmol/l. CALCIUM COMPENSATION: Depends on initial PATIENT IONISED CALCIUM level see table 1 below. Patient Ionised Calcium Starting Calcium Compensation (%) Less than 1mmol/L 110% AND give 10mls calcium chloride 10% over 30 mins before starting mmol/l 110% mmol/l 100% Greater than 1.3mmol/L 90% Table 1: Initial Calcium Compensation INITIAL FLOW SETTINGS: Based on Weight. See table 2 below. Weight (Actual in Kg) (Round up to nearest whole kg) INITIAL SETTINGS WITH CITRATE DOSE of 3 mmols/l blood Blood Flow mls/min Dialysis rate mls/hr Replacement (post filter) rate mls/hr Actual Renal Replacement Dose Up to mls/kg/hr 51 to mls/kg/hr 61 to mls/kg/hr 71 to mls/kg/hr 81 to mls/kg/hr 91 to mls/kg/hr 101 to mls/kg/hr 111 to mls/kg/hr 121 and up mls/kg/hr Table 2: Initial Flow Settings CONNECTION (see Picture 1) 1. Connect access line to patient VasCath (red). 2. Connect yellow line to effluent bag. 3. Connect calcium chloride line to available port on Y connector. 4. Disconnect Y connector from priming bag and attach to Vascath (blue). 5. Connect blue return line to the vacated port on the Y connector. 6. Tape together calcium and return line (near patient). 7. Unclamp lines (as per machine). 8. Press start treatment (note the time). NB: Avoid swapping lines unless absolutely necessary. If lines are swapped ensure the lines are clearly labelled, and the reason for the change is documented. BCU Citrate Guideline v6 Nov 2015 (Approved by CCSC May 15) 3
4 Picture 1: Connecting Tubing to VasCath. BCU Citrate Guideline v6 Nov 2015 (Approved by CCSC May 15) 4
5 Treatment Monitoring Low PATIENT IONISED CALCIUM values should ALWAYS be attended to as a priority as it will have the biggest impact on patient physiology and stability. If at any time during treatment the patient s ionised calcium is less than 0.7 mmol/l, administer 10mL calcium chloride 10% through peripheral or central line. The PATIENT IONISED CALCIUM from the patient s arterial line* is used to ensure that enough calcium chloride is being given to the patient to replace the calcium used up in the reaction with the citrate. A PATIENT IONISED CALCIUM of >1 is required TO KEEP THE PATIENT SAFE from the effects of hypocalcaemia. The calcium replacement, initially estimated by the Prismaflex machine, may need to be changed based on these results. The FILTER IONISED CALCIUM (from the blue port on the Prismaflex [i.e. post filter]) is checked on the blood gas machine to ensure that enough calcium is being removed by the citrate infusion via the pre-blood pump. A FILTER IONISED CALCIUM concentration of mmol/l is required TO PREVENT FILTER CLOTTING. The citrate dose, initially based on patient weight, may need to be changed based on these results. So, once treatment is initiated and blood flow established, wait 60 minutes then check the: PATIENT IONISED CALCIUM from the patient s arterial line*. FILTER IONISED CALCIUM (from blue port on Prismaflex). The table below gives the timings of the FILTER IONISED CALCIUM and PATIENT IONISED CALCIUM checks (as well as other blood tests which will be needed). Parameter Initial check And then FILTER IONISED CALCIUM ABG from blue port on circuit Target 0.25 to 0.50 mmol/l PATIENT IONISED CALCIUM ABG from arterial line* Target 1.00 to 1.30 mmol/l Hourly until stable** Hourly until stable** 6 Hourly 6 Hourly TOTAL CALCIUM yellow tube sent to lab Target 2.20 to 2.50 mmol/l After 6 hours Daily TOTAL CALCIUM to PATIENT IONISED CALCIUM ratio Target ratio <2.5 After 6 hours U&E 6 hourly 12 hourly when stable FBC/haematocrit Daily Daily Magnesium/phosphate Daily Daily Glucose As per protocol As per protocol Table 3: Frequency of blood tests. *Or central line, or peripheral venesection: the point is that it comes from the patient, not the machine. ** Stable = No changes required for 2 consecutive hours Daily BCU Citrate Guideline v6 Nov 2015 (Approved by CCSC May 15) 5
6 Treatment Monitoring continued Adjust the Calcium Compensation and Citrate Dose based on the table below. Adjustments are made through the Anticoag screen. Filter Ionised Calcium >0.50 Filter Ionised Calcium Filter Ionised Calcium <0.25 Patient Ionised Calcium < 1.0 Citrate dose increased by 0.5mmols/L blood AND Calcium compensation increased by 10% Calcium compensation increased by 10% Citrate dose decreased by 0.5mmols/L blood Patient Ionised Calcium Citrate dose increased by 0.5mmols/L blood Normal Ideal Values Citrate dose decreased by 0.5mmols/L blood Patient Ionised Calcium > 1.3 Calcium compensation decreased by 10% Calcium compensation decreased by 10% Calcium compensation decreased by 10% AND Citrate dose decreased by 0.5mmols/L blood RECHECK ONE HOUR AFTER ANY CHANGE Table 4: Adjusting Calcium and Citrate Dose With the exceptions given in the table above, aim to make only one adjustment at a time. Then recheck for desired effect in one hour. Making multiple changes to citrate dose, calcium compensation, blood flow or dialysis flow simultaneously will make the interpretation of actions and subsequent troubleshooting difficult. Total calcium to ionized calcium ratio monitoring A high total calcium to ionized calcium ratio is a surrogate marker of citrate toxicity. To obtain the value, perform the following calculation manually TOTAL CALCIUM PATIENT IONISED CALCIUM. Note that it is the total calcium and not the corrected calcium that is used in the equation. After 6 hours of treatment commencing, request a total calcium from the lab (yellow tube, best sent with U&Es). However, increasing calcium compensation in the preceding hours could indicate citrate accumulation. In these circumstances, a total calcium level may be checked before the 6 hour mark. Ratio Action <2.5 Check ratio daily >2.5 Consult medical staff. Stop the PrismoCitrate for 20 minutes and restart afterwards with 70% of prior citrate dose. Leave the calcium unchanged. This should result in a slightly higher filter ionised calcium. (0.4 to 0.5 acceptable) If ratio remains above 2.5 despite filter Ionised calcium of mmol/L then consider: 1. Doubling baseline dialysate flow (will increase citrate clearance) 2. Reducing blood pump speed (will reduce total administered citrate dose). 3. Stopping citrate and using an alternative anticoagulant (or no anticoagulant) Table 5: Citrate Accumulation. BCU Citrate Guideline v6 Nov 2015 (Approved by CCSC May 15) 6
7 Troubleshooting Acid/Base Disturbances BLOOD GASES POSSIBLE REASON POTENTIAL SOLUTIONS TO CONSIDER ph > 7.45 and BE > +5 Too much citrate (metabolised by the liver to bicarbonate). Boost citrate removal in dialysis by increasing dialysis flow by 500mLs/hr. Maximum dialysis dose of 3000mLs/hr. Or: Consider reducing citrate dose to patient by reducing blood flow rate in 20mLs/min increments. Or: Consider accepting higher post filter ionised calcium by reducing citrate dose by 0.5mmol/L ph < 7.35 and BE < -5 Total calcium and patient ionised calcium normal NB: NORMAL LIVER FUNCTION Metabolic acidaemia more citrate may help Reduce dialysis dose to reduce clearance of citrate, thus increasing citrate buffer load to patient. Or: Consider increasing blood flow rate, which will increase citrate dose. Or: Consider systemic sodium bicarbonate infusion. ph < 7.35 and BE < -5 Total calcium increased; patient ionised calcium normal or decreased Ratio of total Ca/ionised Ca > 2.5 Patient Acidaemic - too much citrate (and the liver can t handle it) Only generally seen in liver dysfunction CONSULTANT DISCUSSION REQUIRED See Section on total calcium to ionised calcium ratio Table 6: Acid/Base RECHECK BLOODS ONE HOUR AFTER ANY CHANGE ALWAYS REVIEW UNDERLYING PATHOLOGY BCU Citrate Guideline v6 Nov 2015 (Approved by CCSC May 15) 7
8 Frequently Asked Questions Q. Is heparin used to prime the circuit? No. However patient s lines should be hep-locked at the end of treatment. Q. My patient is septic, and I want to increase my dose of RRT. How can I do this? Increase the replacement by 10ml/kg/hr. For example, if you have a 70kg patient receiving a total RRT dose of 35ml/kg/hr, and you want to up it to 45, then increase their replacement by 700ml/hr. Q. What do I do if I want to increase clearance? Depending on solute to be removed, either increase replacement flow or dialysate flow or alternatively move patient up to the next weight bracket. Changes to blood flow and dialysate flow rates will affect the citrate and calcium doses delivered. So change flow rates with caution. Increases to post filter replacement flow should not have a demonstrable effect on patient ionised calcium or citrate requirements. Increasing replacement rates to increase effluent dose does NOT require a change in dialysis flow UNLESS the blood flow rate is changed also. Q. How quickly does a change in citrate dose have its effect? Changes to citrate dose will have a rapid effect on post filter calcium concentration, usually within 5 to 10 mins. Q. The protocol says to reduce the citrate dose, and now the overall effluent dose has dropped. What should I do? Should the protocol stipulate that the citrate dose be reduced, pre-blood pump flow and hence total effluent dose will also fall. If the total effluent dose falls below 30mls/kg/hr as a result, increase the replacement flow until a dose of 30mls/kg/hr is achieved. Q. My calcium compensation is very high. Is that normal? There are lots of reasons why a patient s calcium needs can increase, but if calcium compensation is above 150% this could indicate citrate accumulation (citrate is not being metabolised and calcium is not being released). Check patient total calcium/patient ionised calcium ratio if >2.5 follow protocol guideline above. Q. What do I do if my bicarbonate is consistently low? This could be a sign of citrate accumulation. Check calcium ratio. If within normal levels, consider giving bicarbonate. Q. My calcium levels remain high, or are suddenly very low. What s going on? If post filter ionised calcium remains high with increasing citrate doses then check that the correct arrangment and type of fluid has been installed on the replacement and dialysis lines. A sudden and unexplained drop in the patient ionised calcium value and high post filter calcium should signal to check the PrismoCitrate bag has been installed correctly on the pre blood pump and not the replacement line! Q. Should I recheck bloods if the calcium chloride (CaCl) infusion adjusts by a very small amount? Sometimes the calcium chloride infusion will adjust by mls when the Prismaflex attempts to compensate for downtime when pumps have been stopped. No checks are required at very small levels if you are happy that there have been recent reasons for pumps being stopped (e.g. for bag changes). Q. How should citrate be re-started following a circuit change? If a new circuit is started in less than an hour after stopping, then start at the previous levels of citrate and calcium compensation. If more than an hour, then start all over again as if with a new patient. BCU Citrate Guideline v6 Nov 2015 (Approved by CCSC May 15) 8
9 Q. Why do I keep getting calcium line clamped alarm?? Before filling syringe, pump the plunger up and down in the barrel of the syringe to improve movement. After making up your syringe, discard some of the volume so that syringe volume is below 50mls. If alarm still persists consider moving calcium line to patient s central line. Q. How can I avoid machine interruptions? Ensuring machine interruptions are kept to a minimum will maintain continuous blood circulation and therefore seamless therapy. The following will help: Do not persist with therapy if ve access pressure (>200mmHg) unresolved within 5-10 minutes (contact Superuser/Consultant for advice immediately) Recirculate blood in set ASAP in order to give time (60 mins) for VasCath manipulation (as required) or other lengthy procedures that reduce VasCath patency. Ensure movement of fluid bags is kept to a minimum. Q. The filter has clotted early despite following the protocol. What should I do? If the patient demonstrates early filter clotting (less than 72 hours) then consider a lower target of FILTER IONISED CALCIUM of mmol/L by increasing the citrate dose by 0.2mmols/L from the previous dose. Be aware of risks of citrate accumulation and metabolic alkalosis. Q. Does citrate affect drug pharmacokinetics or clearance? Not appreciably. BCU Citrate Guideline v6 Nov 2015 (Approved by CCSC May 15) 9
10 APPENDIX: FLUID INFORMATION PrismoCitrate 18/0 Predilution anticoagulant (mmol/l) (white scale) Citrate 18 Na 140 Cl 86 K 0 PrismOcal B22 Dialysate (mmol/l) (green scale) Na 140 Cl 120 Lactate 3 HCO3 22 K 4 Glucose 6.1 Mg 0.75 Calcium None Prismasol 4 Replacement (mmol/l)(purple scale) Na 140 Cl Lactate 3 HCO3 32 K 4 Glucose 6.1 Mg 0.5 Calcium 1.75 BCU Citrate Guideline v6 Nov 2015 (Approved by CCSC May 15) 10
11 Who contact with questions/ queries regarding citrate therapy CSIG superusers: Dr John Glen For all Prismaflex machine questions/ queries: Prismaflex Helpline BCU Citrate Guideline v6 Nov 2015 (Approved by CCSC May 15) 11
Education Pack and Workbook for Citrate Anticoagulation via Prismaflex
Education Pack and Workbook for Citrate Anticoagulation via Prismaflex Name Completion Date Assessed by (Superuser) Signature of Assessor Citrate Workbook v6 Nov 2015 1 Contents Introduction 3 CSIG Members
More information404FM.2 CONTINUOUS RENAL REPLACEMENT THERAPY (CRRT) USING CITRATE Target Audience: Hospital only ICU. (Based on Gambro and Kalmar Hospital protocols)
404FM.2 CONTINUOUS RENAL REPLACEMENT THERAPY (CRRT) USING CITRATE Target Audience: Hospital only ICU (Based on Gambro and Kalmar Hospital protocols) CRRT using regional citrate anticoagulation This is
More informationST. DOMINIC-JACKSON MEMORIAL HOSPITAL JACKSON, MISSISSIPPI. CONTINUOUS RENAL REPLACEMENT THERAPY (CRRT) HEPARIN ANTICOAGULATION Page 1 of 5
HEPARIN ANTICOAGULATION Page 1 of 5 Pharmacy Mnemonic: CRRTHEP1 PATIENT DATA: DIAGNOSIS: AKI ESRD Other: WEIGHT: Today: kg Admission Weight:: kg Dry Weight: kg Access TYPE: Temporary Dialysis Catheter
More informationActive UMMC Protocols
UMMC CRRT 2018 Active UMMC Protocols 1. Standard CRRT Protocol PrismaFlex & NxStage CVVH with Fixed Ratio Regional Citrate Anticoagulation 2. No Anticoagulation Protocol PrismaFlex & NxStage CVVH with
More informationLess than 50kgs protocol
Less than 50kgs protocol WELCOME TO THE WORLD OF CONTINUOUS RENAL REPLACEMENT THERAPY This clinical guideline package has been put together to endeavour to supply the user (both medical and nursing) with
More informationBPG 03: Continuous Renal Replacement Therapy (CRRT)
BPG 03: Continuous Renal Replacement Therapy (CRRT) Statement of Best Practice Patient s requiring Continuous Renal Replacement Therapy (CRRT) will receive appropriate therapy to meet their individual
More informationUNDERSTANDING THE CRRT MACHINE
UNDERSTANDING THE CRRT MACHINE Helen Dickie Renal Sister Critical Care Unit Guy s and St.Thomas NHS Foundation Trust 18.10.14 RRT options - IHD vs CRRT (1) Intermittent HaemoDialysis e.g. 4hrs daily or
More informationCONTINUOUS RENAL REPLACEMENT THERAPY (CRRT)
TABLE OF CONTENTS The purpose of this practice support document is to outline the procedures and guidelines related to care of the patient having continuous renal replacement therapy (CRRT) in the pediatric
More informationImplementing therapy-delivery, dose adjustments and fluid balance. Eileen Lischer MA, BSN, RN, CNN University of California San Diego March 6, 2018
Implementing therapy-delivery, dose adjustments and fluid balance. Eileen Lischer MA, BSN, RN, CNN University of California San Diego March 6, 2018 Objectives By the end of this session the learner will
More informationPICANet Custom Audit Definitions Renal Dataset
PICANet Custom Audit s Renal Dataset Version 1.0 (July 2016) PICANet Renal Custom Audit Data s Manual Version 1.0 July 2016 Renal Dataset Contents PICANet Custom Audit s... 1 Renal Dataset... 1 Version
More informationSt George Hospital Renal Department Internal Policy
SUMMARY: TROUBLESHOOTING POOR BLOOD FLOW IN VASCATHS: Please see the flow chart at the end of the protocol describing possible causes to be considered and how to deal with these in a systematic fashion.
More informationCRRT Fundamentals Pre- and Post- Test. AKI & CRRT Conference 2018
CRRT Fundamentals Pre- and Post- Test AKI & CRRT Conference 2018 Question 1 Which ONE of the following statements regarding solute clearance in CRRT is MOST correct? A. Convective and diffusive solute
More informationUAB CRRT Primer Ashita Tolwani, MD, MSc University of Alabama at Birmingham
UAB CRRT Primer 2018 Ashita Tolwani, MD, MSc University of Alabama at Birmingham 1 CRRT Primer Continuous Renal Replacement Therapy (CRRT) is a "catch all" term used for all the continuous modes of renal
More informationManaging Acid Base and Electrolyte Disturbances with RRT
Managing Acid Base and Electrolyte Disturbances with RRT John R Prowle MA MSc MD MRCP FFICM Consultant in Intensive Care & Renal Medicine RRT for Regulation of Acid-base and Electrolyte Acid base load
More informationAdmission Day 2 Na Potassium Cl Bicarb BUN Cr Hb Hct platelets
Nithin Karakala Mr. Clark Kent was admitted to the hospital with multiple injuries after an epic battle with the Kryptonians. He was hypotensive at the time of admission. Over the next 24 hours he develops
More informationOperation-Fluids-Electrolytes-Acid Base COMPLICATIONS OF DIALYSIS 2
Operation-Fluids-Electrolytes-Acid Base COMPLICATIONS OF DIALYSIS 2 Maureen Craig, RN, MSN, CNN University of California Davis Medical Center Sacramento, California macraig@ucdavis.edu Hospital Details
More informationSession 1: Circuit, Anticoagulation and Monitoring. Ashita Tolwani, MD, MSc Noel Oabel, BSN, RN, CNN 2019
Session 1: Circuit, Anticoagulation and Monitoring Ashita Tolwani, MD, MSc Noel Oabel, BSN, RN, CNN 2019 Goals n Learn how to set up citrate anticoagulation for CVVH, CVVHD, CVVHDF using Prismaflex n Determine
More informationPICANet Custom Audit Definitions Renal Dataset
PICANet Custom Audit s Renal Dataset Version 2.0 (March 2017) PICANet Renal Custom Audit Data s Manual Version 2.0 29/03/2017 Renal Dataset Contents PICANet Custom Audit s... 1 Renal Dataset... 1 Version
More informationReference ID:
HIGHLIGHTS OF PRESCRIBING INFORMATION These highlights do not include all the information needed to use PRISMASOL and PHOXILLUM safely and effectively. See full prescribing information for PRISMASOL and
More informationPackage leaflet: information for the user. Prismasol 2 mmol/l Potassium Solution for haemodialysis/haemofiltration
Package leaflet: information for the user Prismasol 2 mmol/l Potassium Solution for haemodialysis/haemofiltration Calcium chloride dihydrate/ magnesium chloride hexahydrate/ glucose monohydrate/ lactic
More informationHNE Area Intensive Care. Continuous Renal Replacement Therapy in Intensive Care(CRRT)
HNE Area Intensive Care Guideline approved for : JHH ICU only Practice Guideline Continuous Renal Replacement Therapy in Intensive Care(CRRT) CRRT is a form of Renal replacement therapy which is used predominantly
More informationModule 7 Your Blood Work
Module 7 Your Blood Work Every month you will need to collect a sample of your blood just before you start dialysis, and depending on your doctor s recommendation, at the end of your dialysis treatment.
More information*Sections or subsections omitted from the full prescribing information are not 6 ADVERSE REACTIONS
HIGHLIGHTS OF PRESCRIBING INFORMATION These highlights do not include all the information needed to use PRISMASOL and PHOXILLUM safely and effectively. See full prescribing information for PRISMASOL and
More informationMODALITIES of Renal Replacement Therapy in AKI
MODALITIES of Renal Replacement Therapy in AKI Jorge Cerdá, MD, MS, FACP, FASN Clinical Professor of Medicine Albany Medical College Albany, NY, USA cerdaj@mail.amc.edu In AKI, RRT is a multidimensional
More informationModule 10 Troubleshooting Guide
Module 10 Troubleshooting Guide Your safety and wellbeing are our priority. Issues can occur during your treatment and it is important that you recognize the symptoms. This guide will teach you how to
More informationCRRT Procedures. and Guidelines. CRRT: Guidelines
CRRT Procedures 2013 and Guidelines Guidelines for the utilization of CRRT (Continuous Renal Replacement Therapies) at Monroe Carell Jr. Children s Hospital at Vanderbilt CRRT: Guidelines CRRT Contacts:
More informationmultibic potassium-free multibic 2 mmol/l potassium multibic 3 mmol/l potassium multibic 4 mmol/l potassium
FRESENIUS MEDICAL CARE Deutschland GmbH Name(s) of the medicinal product(s): -free 2 mmol/l 3 mmol/l 4 mmol/l Pharmaceutical form: Solution for haemodialysis/haemofiltration Procedure number(s): DE/H/0388/001-004/II/030/G
More informationCRRT Interactive Hyperkalemia Cases AKI & CRRT conference 2018
CRRT Interactive Hyperkalemia Cases AKI & CRRT conference 2018 Case 1 Potassium Clearance A 70 kg male is placed on CVVH with a total ultrafiltration rate (effluent rate) of 20 ml/kg/hr. The Blood Flow
More informationCRRT Interactive Hyperkalemia Cases AKI & CRRT conference 2018
CRRT Interactive Hyperkalemia Cases AKI & CRRT conference 2018 Case 1 Potassium Clearance A 70 kg male is placed on CVVH with a total ultrafiltration rate (effluent rate) of 20 ml/kg/hr. The Blood Flow
More informationKit Assembly. Enhanced Simplicity OPERATIONAL BENEFITS. Automatic venous chamber adjustment. User friendly interface
System for CRRT Kit Assembly Enhanced Simplicity User friendly interface Flexible AcuSmart touch screen can be turned 180 degrees with up to 100 degrees of tilt in order to ensure visibility from various
More informationCRRT Fundamentals Pre-Test. AKI & CRRT 2017 Practice Based Learning in CRRT
CRRT Fundamentals Pre-Test AKI & CRRT 2017 Practice Based Learning in CRRT Question 1 A 72-year-old man with HTN presents to the ED with slurred speech, headache and weakness after falling at home. He
More informationCan We Achieve Precision Solute Control with CRRT?
Can We Achieve Precision Solute Control with CRRT? Claudio Ronco, M.D. David Selewski, M.D. Rolando Claure-Del Granado, M.D. AKI & CRRT Conference February, 2019 Disclosures I have no actual or potential
More informationCitrate Anticoagulation
Strategies for Optimizing the CRRT Circuit Citrate Anticoagulation Prof. Achim Jörres, M.D. Dept. of Nephrology and Medical Intensive Care Charité University Hospital Campus Virchow Klinikum Berlin, Germany
More informationTechnical aspects of RRT in AKI: access, anticoagulation, drug dosage and nutrition. Marlies Ostermann
Technical aspects of RRT in AKI: access, anticoagulation, drug dosage and nutrition Marlies Ostermann AKI guideline Chapter 3: Nutrition Chapter 5.3: Anticoagulation Chapter 5.4: Vascular access for RRT
More informationSt George Hospital Renal Department Guideline: INTERNAL ONLY ANTICOAGULATION - COMMENCEMENT OF HAEMODIALYSIS
ANTICOAGULATION - COMMENCEMENT OF HAEMODIALYSIS Summary Aim: To prevent clotting of the extracorporeal circuit during haemodialysis If there are no contraindications, heparin can be used. In the first
More informationGESTATIONAL DIABETES (DIET/INSULIN/ METFORMIN) CARE OF WOMEN IN BIRTHING SUITE
GESTATIONAL DIABETES (DIET/INSULIN/ METFORMIN) CARE OF WOMEN IN BIRTHING SUITE DEFINITION A disorder characterised by hyperglycaemia first recognised during pregnancy due to increased insulin resistance
More informationPackage leaflet: Information for the user. multibic potassium-free solution for haemodialysis/haemofiltration
Package leaflet: Information for the user multibic potassium-free solution for haemodialysis/haemofiltration Read all of this leaflet carefully before you start using this medicine because it contains
More informationhigher dose with progress in technical equipment. Continuous Dialysis: Dose and Antikoagulation. prescribed and delivered
1 2 Continuous Dialysis: Dose and Antikoagulation higher dose with progress in technical equipment Comparison of pump-driven and spontaneous continuous haemofiltration in postoperative acute renal failure.
More informationCan We Achieve Precision Solute Control with CRRT?
Can We Achieve Precision Solute Control with CRRT? Claudio Ronco, M.D. David Selewski, M.D. Rolando Claure-Del Granado, M.D. AKI & CRRT Conference February, 2019 Disclosures I have no actual or potential
More informationINTRAVENOUS FLUID THERAPY
INTRAVENOUS FLUID THERAPY PRINCIPLES Postnatal physiological weight loss is approximately 5 10% in first week of life Preterm neonates have more total body water and may lose 10 15% of their weight in
More informationTYPE 1 DIABETES MELLITIS CARE OF WOMEN IN BIRTHING SUITE
TYPE 1 DIABETES MELLITIS CARE OF WOMEN IN BIRTHING SUITE DEFINITION Type 1 Diabetes: described as a total lack of insulin produced by the pancreas for the requirements of the tissues. If left untreated,
More informationRegional Citrate Anticoagulation for RRTs in Critically Ill Patients with AKI
In-Depth Review Regional Citrate Anticoagulation for RRTs in Critically Ill Patients with AKI Santo Morabito,* Valentina Pistolesi,* Luigi Tritapepe, and Enrico Fiaccadori Abstract Hemorrhagic complications
More informationTHERAPEUTIC PLASMA EXCHANGE
THERAPEUTIC PLASMA EXCHANGE DIRECTORATE OF NEPHROLOGY AND TRANSPLANTATION Background and Indications Therapeutic plasma exchange (TPE) is an extracorporeal blood purification technique in which plasma
More informationATI Skills Modules Checklist for Central Venous Access Devices
For faculty use only Educator s name Score Date ATI Skills Modules Checklist for Central Venous Access Devices Student s name Date Verify order Patient record Assess for procedure need Identify, gather,
More informationMatthew J Brain, Owen S Roodenburg, Natalie Adams, Phoebe McCracken, Lisen Hockings, Steve Musgrave, Warwick Butt and Carlos Scheinkestel.
Randomised trial of software algorithm-driven regional citrate anticoagulation versus heparin in continuous renal replacement therapy: the Filter Life in Renal Replacement Therapy pilot trial Matthew J
More informationCRRT: The Technical Questions Modality & Dose. Ashita J. Tolwani, MD, MSc University of Alabama at Birmingham 2018
CRRT: The Technical Questions Modality & Dose Ashita J. Tolwani, MD, MSc University of Alabama at Birmingham 2018 Case A 24YOM with HTN and OSA presents with acute pancreatitis. Despite aggressive fluid
More informationCRRT in Pediatrics: Indications, Techniques & Outcome. Overview
CRRT in Pediatrics: Indications, Techniques & Outcome Timothy E. Bunchman Pediatric Nephrology & Transplantation Grand Rapids, MI Overview (Please interrupt me at any time) Access Solutions Anticoagulation
More informationPHARMACOLOGY AND PHARMACOKINETICS
DRUG GUIDELINE Insulin, human neutral (Actrapid ) Intravenous Infusion for SCOPE (Area): FOR USE IN: Critical Care Unit, Emergency Department and Operating Suite EXCLUSIONS: Paediatrics (seek Paediatrician
More informationStefano Romagnoli, M.D., Ph.D.
CORSO CRRT Stefano Romagnoli, M.D., Ph.D. Dip. di Anestesia e Rianimazione AOU Careggi - Firenze Come mantenere la pervietà e il perfetto funzionamento del circuito. Diversi regimi di anticoagulazione.
More informationVolumetric Infusion Pumps - Delivering Volume with Accuracy
Volumetric Infusion Pumps - Delivering Volume with Accuracy INFUSION MANAGEMENT Accuracy you can rely on Paediatric Model 505 Model 500 Recognised in intensive care units, general wards and specialist
More informationContinuous renal replacement therapy. David Connor
Continuous renal replacement therapy David Connor Overview Classification of AKI Indications Principles Types of CRRT Controversies RIFL criteria Stage GFR Criteria Urine Output Criteria Risk Baseline
More informationPICANet Renal Dataset supplement Renal Daily Interventions
PICANet Renal Dataset supplement Renal Daily Interventions Version 2.0 (March 2017) 1 Contents PICANet Renal Dataset supplement... 1 Renal Daily Interventions... 1 Version 2.0 (March 2017)... 1 Recording
More informationChapter 8 ADMINISTRATION OF BLOOD COMPONENTS
Chapter 8 ADMINISTRATION OF BLOOD COMPONENTS PRACTICE POINTS Give the right blood product to the right patient at the right time. Failure to correctly check the patient or the pack can be fatal. At the
More informationINTRAVENOUS FLUIDS PRINCIPLES
INTRAVENOUS FLUIDS PRINCIPLES Postnatal physiological weight loss is approximately 5-10% Postnatal diuresis is delayed in Respiratory Distress Syndrome (RDS) Preterm babies have limited capacity to excrete
More informationCATHETER ACCESS KIT. For use with Prometra Programmable Infusion Systems
CATHETER ACCESS KIT Caution: Federal (USA) Law restricts this device to sale by or on the order of a physician. Table of Contents Contents... 3 Description... 3 Indications... 3 Contraindications... 3
More informationCRRT Fundamentals Pre- and Post- Test Answers. AKI & CRRT 2017 Practice Based Learning in CRRT
CRRT Fundamentals Pre- and Post- Test Answers AKI & CRRT 2017 Practice Based Learning in CRRT Question 1 A 72-year-old man with HTN presents to the ED with slurred speech, headache and weakness after falling
More informationProlonged Dialysis: 24-hr SLED Is It CRRT? Balazs Szamosfalvi, MD
Prolonged Dialysis: 24-hr SLED Is It CRRT? Balazs Szamosfalvi, MD Medical Director, In-patient Dialysis and CRRT Henry Ford Hospital, Detroit, Michigan, USA Presenter Disclosure Information I will discuss
More informationPRESCRIBING INFORMATION
PRESCRIBING INFORMATION PrismaSOL 4 Calcium chloride dihydrate 5.145 g/l, Glucose anhydrous 22.0 g/l, Lactic acid 5.4g/L, Magnesium chloride hexahydrate 2.033 g/l, Potassium chloride 0.314 g/l, Sodium
More informationSALEM HOSPITAL SALEM, OREGON 97309
SALEM HOSPITAL SALEM, OREGON 97309 Department: Phlebotomy TITLE: BLOOD COLLECTIONS, VENIPUNCTURE Area: Phlebotomy Effective Date: 04/01/96 Authored By: Cindy Humphrey, Diane Duncan Revised: 09/26/2000,
More informationDiagnosis: Allergies with reaction type:
Patient Name: Diagnosis: Allergies with reaction type: CHRONIC HOME HEMODIALYIS ORDERS Version 4 1/21/2013 1. TREATMENT ORDERS A. Frequency of treatment 5 6 times per week. B. Weight and blood pressures,
More informationMANITOBA RENAL PROGRAM
MANITOBA RENAL PROGRAM SUBJECT Use of Closed Needleless Access Device with Hemodialysis Central Venous Catheters (CVC) SECTION CODE 30.20.04 30.20 Vascular Access AUTHORIZATION Professional Advisory Committee,
More informationA quick reference guide to haemofiltration and renal failure
A quick reference guide to haemofiltration and renal failure March 2004 Alison Bradshaw 1 Page 3 Acute Renal Failure Page 4 Normal Kidney Function Page 5 Nephron Function Page 6 Definitions of Key Words
More informationHow to Set Up and Infuse Your TPN
Page 1 of 10 How to Set Up and Infuse Your TPN Important: Do not change any of the supplies listed here. Keep supplies away from children. Only your home care nurse or persons trained by Fairview Home
More informationISOVALERIC ACIDAEMIA -ACUTE DECOMPENSATION (standard version)
Contact Details Name: Hospital Telephone: This protocol has 5 pages ISOVALERIC ACIDAEMIA -ACUTE DECOMPENSATION (standard version) Please read carefully. Meticulous treatment is very important as there
More informationThere are number of parameters which are measured: ph Oxygen (O 2 ) Carbon Dioxide (CO 2 ) Bicarbonate (HCO 3 -) AaDO 2 O 2 Content O 2 Saturation
Arterial Blood Gases (ABG) A blood gas is exactly that...it measures the dissolved gases in your bloodstream. This provides one of the best measurements of what is known as the acid-base balance. The body
More information03/19/2019. Michael Zappitelli, MD, MSc Hospital for Sick Children, Toronto. Symposium on Pediatric Dialysis, ADC, Dallas, 2019
Michael Zappitelli, MD, MSc Hospital for Sick Children, Toronto Symposium on Pediatric Dialysis, ADC, Dallas, 2019 Baxter: Reimbursed for a CRRT workshop to PICU nurses Slides: S. Goldstein D. Askenazi
More informationRecent advances in CRRT
Recent advances in CRRT JAE IL SHIN, M.D., Ph.D. Department of Pediatrics, Severance Children s Hospital, Yonsei University College of Medicine, Seoul, Korea Pediatric AKI epidemiology and demographics
More informationNEW ZEALAND DATA SHEET
1 HEMOSOL B0 (solution, dialysis) NEW ZEALAND DATA SHEET 2 QUALITATIVE AND QUANTITATIVE COMPOSITION Hemosol B0, is a solution for haemodialysis and haemofiltration consisting of a mixture of the following
More informationOrgan Donor Management Recommended Guidelines ADULT CARDIAC DEATH (DCD)
Date: Time: = Always applicable = Check if applicable ADMISSION INSTRUCTIONS Move to Comfort Care Note in chart. Contact initiated with BC Transplant Consent for Organ Donation obtained Code Status: Full
More informationCRRT for the Experience User 1. Claudio Ronco, M.D. David Selewski, M.D. Rolando Claure-Del Granado, M.D. AKI & CRRT Conference March, 2018
CRRT for the Experience User 1 Claudio Ronco, M.D. David Selewski, M.D. Rolando Claure-Del Granado, M.D. AKI & CRRT Conference March, 2018 Disclosures I have no actual or potential conflict of interest
More informationMetabolismo del citrato nei pazienti critici. Filippo MARIANO Dipartimento di Area Medica, SCDO di Nefrologia e Dialisi Ospedale CTO, Torino
Metabolismo del citrato nei pazienti critici Filippo MARIANO Dipartimento di Area Medica, SCDO di Nefrologia e Dialisi Ospedale CTO, Torino Regional citrate anticoagulation: the history First in hemodialysis
More informationCalcium flux in continuous venovenous haemodiafiltration with heparin and citrate anticoagulation
Calcium flux in continuous venovenous haemodiafiltration with heparin and citrate anticoagulation Matthew Brain, Scott Parkes, Peter Fowler, Iain Robertson and Andrew Brown Renal replacement therapy (RRT)
More informationCOMPLIANCE WITH THIS DOCUMENT IS MANDATORY
COVER SHEET `NAME OF DOCUMENT TYPE OF DOCUMENT at Shoalhaven Hospital Group Critical Care Procedure DOCUMENT NUMBER DATE OF PUBLICATION February 2018 RISK RATING Medium REVIEW DATE February 2021 FORMER
More information2 QUALITATIVE AND QUANTITATIVE COMPOSITION
SUMMARY OF PRODUCT CHARACTERISTICS 1 NAME OF THE MEDICINAL PRODUCT Gambrosol trio 10, solution for peritoneal dialysis 2 QUALITATIVE AND QUANTITATIVE COMPOSITION Gambrosol trio 10 is filled in a three-compartment
More informationNurse-Pharmacist Collaboration in the Delivery of Continuous Renal Replacement Therapy
Cedarville University DigitalCommons@Cedarville Pharmacy Faculty Presentations School of Pharmacy 2-23-2012 Nurse-Pharmacist Collaboration in the Delivery of Continuous Renal Replacement Therapy Jeb Ballentine
More informationMEDICAL EQUIPMENT II HEMODIALYSIS
MEDICAL EQUIPMENT II - 2012 HEMODIALYSIS Lecture 1 Prof. Yasser Mostafa Kadah Hemodialysis Machines Single-patient hemodialysis machines deliver a patient s dialysis prescription by controlling blood and
More informationEducation for self administration of intravenous therapy HOME IV THERAPY. 30 minute - Baxter Pump Tobramycin
HOME IV THERAPY Tobramycin Tobramycin Check the order on the drug chart This can change when the results from your blood test come through. Your doctor will change the order, if required. A copy of the
More informationMeasuring Sodium in dialysis patients. UCL Center for Nephrology
Measuring Sodium in dialysis patients UCL Center for Nephrology sodium Na-heparin sulphate Na-dermatan sulphate Na-chondroitin sulphate endothelium Na-heparin sulphate Na-Sulfate plasma protein Na-Citrate
More informationECMO & Renal Failure Epidemeology Renal failure & effect on out come
ECMO Induced Renal Issues Transient renal dysfunction Improvement in renal function ECMO & Renal Failure Epidemeology Renal failure & effect on out come With or Without RRT Renal replacement Therapy Utilizes
More informationRenal Replacement Therapy in ICU. Dr. Sunil Sharma Senior Resident Dept of Pulmonary Medicine
Renal Replacement Therapy in ICU Dr. Sunil Sharma Senior Resident Dept of Pulmonary Medicine Introduction Need for RRT in patients with ARF is a common & increasing problem in ICUs Leading cause of ARF
More informationNeonatal Parenteral Nutrition Guideline Dr M Hogan, Maire Cullen ANNP, Una Toland Ward Manager, Sandra Kilpatrick Neonatal Pharmacist
CLINICAL GUIDELINES ID TAG Title: Author: Designation: Speciality / Division: Directorate: Neonatal Parenteral Nutrition Guideline Dr M Hogan, Maire Cullen ANNP, Una Toland Ward Manager, Sandra Kilpatrick
More informationVolumetric Infusion Pumps INFUSIONMANAGEMENT
Volumetric Infusion Pumps when accuracy matters INFUSIONMANAGEMENT VOLUMETRIC INFUSION PUMPS Specification - Volumetric Infusion Pump Weight 5kg Dimensions Operating temperatures Including pole clamp Height
More informationSection 3: Prevention and Treatment of AKI
http://www.kidney-international.org & 2012 KDIGO Summary of ommendation Statements Kidney International Supplements (2012) 2, 8 12; doi:10.1038/kisup.2012.7 Section 2: AKI Definition 2.1.1: AKI is defined
More informationDR J HARTY / DR CM RITCHIE / DR M GIBBONS
CLINICAL GUIDELINES ID TAG Title: Author: Speciality / Division: Directorate: Paracetamol Poisoning DR J HARTY / DR CM RITCHIE / DR M GIBBONS Medicine Acute Date Uploaded: 16 th September 2014 Review Date
More informationThe kidney. (Pseudo) Practical questions. The kidneys are all about keeping the body s homeostasis. for questions Ella
The kidney (Pseudo) Practical questions for questions Ella (striemit@gmail.com) The kidneys are all about keeping the body s homeostasis Ingestion Product of metabolism H 2 O Ca ++ Cl - K + Na + H 2 O
More informationEssential in Renal Replacement Therapy Pediatrics CRRT
Essential in Renal Replacement Therapy Pediatrics CRRT Konggrapun Srisuwan MD. Dialysis and Transplantation Program, Department of Pediatrics, Phramongkutklao Hospital Correction of fluid overload in patients
More informationI. Subject: Ionized Calcium (Ca++) Analysis Whole Blood
I. Subject: Ionized Calcium (Ca++) Analysis Whole Blood II. Method: i-stat III. Principle: A. Ca++: is measured by ion-selective electrode potentiometry. Concentrations are calculated from the measured
More informationPRESCRIBING INFORMATION. Prism0CAL B22K0/0. Sodium chloride 7.14 g/l, Magnesium chloride hexahydrate 3.05 g/l, Sodium hydrogen carbonate 2.
PRESCRIBING INFORMATION Prism0CAL B22K0/0 Sodium chloride 7.14 g/l, Magnesium chloride hexahydrate 3.05 g/l, Sodium hydrogen carbonate 2.12 g/l Sterile solution for hemodialysis, hemofiltration and hemodiafiltration
More informationSUMMARY OF PRODUCT CHARACTERISTICS
SUMMARY OF PRODUCT CHARACTERISTICS 1. NAME OF THE VETERINARY MEDICINAL PRODUCT Aqupharm 3 Solution for Infusion 2. QUALITATIVE AND QUANTITATIVE COMPOSITION Active ingredients Sodium Chloride Glucose Anhydrous
More informationWritten Guidelines for Laboratory Testing in Intensive Care - Still Effective After 3 Years
Written Guidelines for Laboratory Testing in Intensive Care - Still Effective After 3 Years S. M. MEHARI, J. H. HAVILL Intensive Care Unit, Waikato Hospital, Hamilton, NEW ZEALAND ABSTRACT Objective: The
More informationContinuous Renal Replacement Therapy in PICU: explanation/definitions/rationale/background
Continuous Renal Replacement Therapy in PICU: explanation/definitions/rationale/background Index: 1. Introduction Pg. 1 1.1 Definitions Pg. 2 1.2 Renal replacement therapy principles Pg. 2 2. Continuous
More informationSUPPORTING INFORMATION. for
SUPPORTING INFORMATION for RAPID RESPONSE REPORT NPSA/2008/RRR06 Problems with infusions and sampling from arterial lines 28 July 2008 Background Review of Evidence of Harm NPSA National Reporting and
More informationEmergency clamp should always be readily available in case of accidental catheter fracture
Note: Please see individual policies for further information. Flushing best practice: Always use a 10 diameter syringe or larger when first accessing and when flushing vascular access device (VAD) Use
More informationDirect Intravenous (IV) Medication Administration Procedure
Approved by: Chief Medical Officer; and Chief Operating Officer Direct Intravenous (IV) Medication Administration Procedure Corporate Policy & Procedures Manual Number: VII-B-310 Date Approved January
More informationCRRT: QUALITY MANAGEMENT SYSTEMS
CRRT: QUALITY MANAGEMENT SYSTEMS Javier A. Neyra, MD, MSCS Director, Acute Care Nephrology & CRRT Program University of Kentucky Medical Center Disclosures and Funding Disclosures Consulting agreement
More informationTumour Lysis Syndrome (TLS)
(TLS) Overview: Tumour lysis syndrome refers to a number of metabolic disturbances (hyperuricaemia, hyperphosphataemia, hyperkalaemia and hypocalcaemia) that occur as the result of rapid cell lysis. This
More informationGUIDELINE FOR HAEMODIALYSIS PRESCRIPTION FOR NEW PATIENTS COMMENCING HAEMODIALYSIS
GUIDELINE FOR HAEMODIALYSIS PRESCRIPTION FOR NEW PATIENTS COMMENCING HAEMODIALYSIS RRCV CMG Nephrology Service 1. Introduction A first acute or chronic haemodialysis session may induce disequilibrium syndrome
More informationTRANSFUSION OF BLOOD COMPONENTS ADMINISTRATION. All blood components are administered according to BOP DHB Policy and NZBS Guidelines.
STANDARDS All blood components are administered according to BOP DHB Policy and NZBS Guidelines. EQUIPMENT IV administration set with 260 micron filter either integrated blood filter; or add on blood filter
More information2019 Home Hemodialysis Standing Orders
2019 Home Hemodialysis Standing Orders 1. Nutrition Standards of Care: A. Follow P&P Nutrition Standards of Care 2. Laboratory Tests: A. Drawn On Admission: 1. Renal Function Panel (BMP, PO 4 and Albumin)
More informationDRUG GUIDELINE. HYDRALAZINE (Intravenous severe hypertension in pregnancy)
DRUG GUIDELINE HYDRALAZINE (Intravenous severe hypertension SCOPE (Area): FOR USE IN: Labour Ward, HDU, Theatre and ED EXCLUSIONS: Paediatrics (seek Paediatrician advice) and other general wards. SCOPE
More information