CRRT Aspect

Question 1

Goals of CRRT

Answer 1

Clearing waste products
Restoration of acid base balance
Correction of electrolyte abnormalities
Management of fluid balance

Question 2

Explain Ultrafiltration

Answer 2

Is the removal of fluid through a pressure gradient. It DOES NOT require dialyse fluid.

High pressure (blood) low pressure (filtrate)
The higher the blood flow, the greater the pressure gradient the greater the potential for ultrafiltration

Question 3

Explain dialysis

Answer 3

Is a continuous movement of dialysis fluid in a counter-current direction to blood flow diffusion occurs as a result.

Question 4

Explain diffusion

Answer 4

The movement of solutes across a semipermeable membrane from a higher concentration to a low concentration

Question 5

CVVHD involves Watch to processes to remove fluid and substrates of blood plasma

Answer 5

Ultrafiltration and diffusion

Question 6

Absorption

Answer 6

The adherence of substrated to the semipermeable membrane

Question 7

Citrate/Calcium (Ci-Ca) and its side effects

Answer 7

Prevents clotting by binding to free calcium in the blood.

1. Hypocalcemia
2. Metabolic alkalosis
3. Citrate intoxication
4. Hypernatraemia

Calcium must be tops up prior to returning blood to the patient as low calcium would result in increase risk of bleeding.

Question 8

Heprin and its side effects

Answer 8

Heparin = half-life 4hrs & disrupt the intrinsic clotting cascade.

1. Heprin induced thrombocytopenia
2. Bleeding

Some patients aren’t able to metabolism the citrate = accumulation resulting in disturbance of acid base balance and very low systematic calcium.

Question 9

If a patient has induced thrombopenia also show signs of citrate accumulation what will be used?

Answer 9

Esoprostenol

Question 10

Esoprostenol and a side effects

Answer 10

Prevents platelet aggregation (acute liver disease, high risk of bleeding, HIT positive)

• The final solution has a high pH
• Potent vasodilator
• several side-effects such as hypertension, Brady/tachycardia pulmonary shunting.

Question 11

What would be used in patients who aren’t able to metabolism the citrate?

Answer 11

Heprin

Question 12

What is needed to monitor a patient on Ci-Ca?

Answer 12

Monitor Calcium levels (formal bloods) and ionised (free) calcium levels (ABG)

Question 13

What to monitor if a patient is on heparin?

Answer 13

APPTr sample from Aline before commencing CRRT

Question 14

What should your monitor if a patient is on Epoprostenol?

Answer 14

Platelet count