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CRRT > CRRT > Flashcards

CRRT Flashcards

1
Q

Function of the kidneys

A

Sodium and water regulation
Excretion of waste products
Electrolyte regulation
Acid/base balance - bicarbonate buffer system
BP control - RAAS system
Stimulation of RBC production (erythropoietin)
Activation of vitamin D

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2
Q

Transmembrane pressure

A

Pressure across the filter membrane

TMP= (filter pressure + return pressure)/2 - effluent pressure

Normal TMP = 0 to 350

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3
Q

Renal indications for CRRT

A 
ARF with oliguria or anuria
Azotemia
Fluid overload in response to diuretics
Sepsis
Cerebral edema
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4
Q

Non renal indications for CRRT

A 
Drug overdose
Metabolic disorders
Crush injuries (haemolysis)
Sever burns
ECMO
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5
Q

Diffusion

A

Movement of solute from an area of high concentration to an area of low concentration

Rate of diffusion depends on:
Filter surface area
Molecule size

Diffusion removes small molecules effectively

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6
Q

Convection

A

The movement of solutes with a water flow “solvent drag”

Used to remove middle and large size molecules
The greater the amount of fluid that moves, the greater the solute loss

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7
Q

Osmosis

A

The tendency of a fluid to move across a semi permeable membrane into an area of high concentration, thus equalising the concentrations on both sides of the membrane

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8
Q

Ultrafiltration

A

Movement of fluid across a pressure gradient

Uses a pressure gradient, whereas diffusion uses a concentration gradient

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9
Q

Adsorption

A

Where molecules that are too large to migrate through the membrane adhere to the membrane itself

Can eventually block the filter and crash the set

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10
Q

SCUF

A

Slow continuous ultrafiltration

Purely fluid removal through a semi permeable membrane
No dialysate and no replacement fluid

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11
Q

CVVH

A

Continuous veno-venous haemofiltraton

Convective dialysis
Uses convection and ultrafiltration
No dialysate
For mid and large sized molecules

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12
Q

CVVHD

A

Continuous veno-venous haemodialysis

Diffusive dialysis
Chemical dialysis, no pressure used
Uses dialysate with a counter That current
No fluid is removed because there is no ultrafiltration

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13
Q

CVVHDF

A

Continuous veno-venous haemodiafiltration

Combines CVVH and CVVHD
Solute removal is achieved by diffusion and convection

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14
Q

TPE

A

Therapeutic plasma exchange

Used in auto immune diseases where plasma exchange is required
Uses a plasma filter instead of a haemofilter

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15
Q

SLED

A

Sustained low efficiency dialysis

Hybrid therapy (between IRT and CRRT)
Same as IRT but with reduced blood flow rates
Called low efficiency but it’s actually higher efficiency than CRRT

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16
Q

Contents of a multibic bag

A

Mmol/L

Na 140
K 0
Ca 1.5
Mag 0.5
Cl 109
HCO3 35
Glucose 5.55

pH is approx 7.2

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17
Q

Access pressure

A

-50 to -150mmHg

Can be positive is using ECMO or a fistula
Can also be positive when starting at low rate

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18
Q

Filter pressure

A

+100 to +250mmHg

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19
Q

Effluent pressure

A

-150 to +150mmHg

Negative or positive depending on the life of the filter (eg. Adsorption makes pump work harder so more negative)

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20
Q

Return pressure

A

+50 to +150mmHg

Same as access pressure but positive

21
Q

Blood leak detector

A

Detects blood in effluent line

22
Q

Air detector

A

Detects air in return line
Clamp will clamp down if air is detected

Need to monitor level in de-airation chamber and adjust as required

23
Q

Green

A

All clear, continue

24
Q

Yellow

A

All pumps stop except blood pump eg. Change bag

25
Q

Red alarm

A

All pumps stop including blood pump eg. Filter clotted

26
Q

Blood flow rate

A

Start at 50mls/hr

Increase to 200ml/hr as haemodynamically tolerated

27
Q

Dialysate rate

A

Run at 20ml/kg/hr

28
Q

Pre blood pump

A

Run at 10ml/kg/hr

29
Q

Post filter replacement

A

Run at 200ml/hr (set rate)

30
Q

Heparin

A

Drawn up 12,500units in 50ml

Run at 4ml hour = 1000units/ hour

31
Q

Protamine

A

Drawn up 100mg in 100ml
1mg reverses 100units of heparin
Therefore run protamine at 10mls/hour

Protamine runs on seperate pump via 3 way tap or on seperate vascath lumen

32
Q

Equipment for connecting filter

A 
Dressing trolley
Dressing pack
Sterile gauze
Chlorhex
Sterile gloves
2 10ml syringes
2 5ml syringes
2 saline ampules
Gogglese
Surgical mask
33
Q

Equipment for disconnecting filter

A 
Dressing trolley
Dressing pack
Sterile gauze
Chlorhex
Sterile gloves
2 10ml syringes
2 5ml syringes
2 saline ampules
Goggles
Surgical mask
Heparin for heparin lock
2 3 ml syringes for heparin lock
34
Q

Extreme negative access pressure

A

Negative pressure measured by access pump
More than -250mmHg

Could be caused by linking, vascath on vessel wall, vascath is occluded, severe hypovolaemia

35
Q

Positive access pressure

A

May be positive when filter first set up and blood pump is only at 50mls
May also be positive with ECMO or filter access

36
Q

Extreme positive return pressure

A

Pressure messed by return pump is more than 300mmHg

Causes
Linking, blocked vascath, vascath against the vessel wall, vascath is dislodged and emptying into haematoma, vascath in artery

37
Q

Extreme positive filter pressure

And

High TMP

A

Alarms when difference between filter and return pressure is more than 250mmHg

Causes
Natural filter degradation eg adsorption
Embolus or clot in filter
Pre blood replacement is set too high

High TMP with normal return pressure = problem with filter
High TMP with high return pressure = problem with filter AND/OR return line

Advisory TMP alarm when TMP is 300
Filter clotted alarm occurs when TMP 450

38
Q

Blood leak detected

A

Look for blood
Test with dip stick

If positive, filter may have ruptured
Need new set

If not positive normalise BLD to recalibrate

39
Q

Air in return line

A

Check for air
Level is too low in de airation chamber
If possible, aspirate air
Otherwise need new set

40
Q

Excessive/inaccurate fluid removal

A

Check correct weight

Check scales for interference

41
Q

Indications for ceasing RRT

A 
Indication for initiating is resolved eg. Drug toxicity resolved
Renal recovery
Fluid state normalised
Electrolyte state normalised 
Transfer to comfort/palliative care
42
Q

What if the filter clots

A

If possible, stop spike start before filter clots

If filter already clotted, need to prime new set

43
Q

What if therapy is to be ceased

A

Blood is returned using saline bag

Connect saline bag to access and press start return

44
Q

What if therapy is to be temporarily ceased

A

Recirculation

Press recirculation option
Connect saline bag to access line
Return the blood by pressure start return
Disconnect patient from return line
Filter can recirculate for 120 mins
45
Q

Normal clotting values

A

INR 1.1-1.3 (2.0-3.0 for warf)
APTT 30-40 seconds
Fibrinogen 1.5-4

46
Q

Molecule sizes

A 
Small
Urea
Creatinine
Na
K

Medium
Vitamin B12
Glucose

Large
Insulin
Albumin

47
Q

Lactate buffer solution is not suitable in which patients?

A

Liver failure
Severe metabolic acidosis

In these cases use bicarbonate buffer solution

48
Q

Pinch valves

A

Can close valves to use pre/post filter replacement or not depending on filter mode

49
Q

How to get rid of static electricity

A

Electrostatic discharger ring

CRRT (1 decks)

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