CRRT_Protocol.ppt
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参见附件(297KB)。
CRRT
Continue Renal Replacement Therapy
Indications
Procedure共同處
?Driving force: external pump
? Circuit : Venovenous
? Dialysis solutions :一般使用1.5% PD solution
? Replacement fluid : several types of replacement fluid can be used , depending on patient requirements ,一般使用 pre-dilution 方式.
Anti-coagulation 的方式
? STANDARD HEPARIN
? TYPICAL REGIMEN IN CRRT :
? Priming of the circuit ( 5000 IU / L )
? Initial Heparin Bolus : 5 - 8 IU / kg
? Infuse Heparin at : 5 to 12 IU / kg / hr
? ACT on post filter : Adjust heparin rate to keep ACT between 1.5 & 2.0 times
STANDARD HEPARIN
LOW MOLECULAR WEIGHT (LMW) HEPARIN
? TYPICAL REGIMEN IN CRRT :
? Priming of the circuit : 20 mg in 1 L
? Maintenance dose : 10 to 40 mg q6 hrs
? Monitor anti- factor Xa (aXa) units . Adjust between 0.1 and 0.4 μ/ml
? Different Dosages for LMW heparin
LOW MOLECULAR WEIGHT (LMW) HEPARIN
Regional Citrate Anticoagulation
? TYPICAL REGIMEN :
? Citrate anticoagulation is always regional
? Citrate infusion (4%) at 170 ml/hr initially
? Special Dialysate at 1 liter/hr ( Na+ 117 ,K+ 4 , Mg++ 1.5 , Cl- 121.5 , dextrose 0.5- 2.5% , no Ca++ , no base )
? CaCL2 (0.75%) by central I.V at 40-60 ml/hr,? Maintain ionized Ca++ at 0.96- 1.20 mmol/L
Citrate
? ADVANTAGES :
? No Bleeding
? No Thrombocytopenia
? Improved Filter Life and Efficacy
Heparin- free methos
? Normal saline flush
? Used in patients with
1. Severe liver disease
2. Acitve or recent bleeding
3. Heparine-induced thrombocytopenia
4. Post-op patients
Dialysis modalities in the ICU
CVVH配置簡圖
CVVH order
?Prepare Heparin 2cc + N/S 3cc, then inject 1.6cc into eachfemoral cath.
?For AK priming: (GAMBRO, Polyarylethersulfone, 6S)
*1st N/S 1000cc.
*2nd Heparin 2,500U.
*3rd N/S 500cc.
? *Prepare Heparin 25,000U + N/S 500cc IVD 10cc/hr with pump to keep aPPT 1.5-2? and adjust as followed:
aPPT bolushold dose(cc/hr)
<1.0? 2000U - +4
1.0-1.5? --+2
1.5-2.0? ---
2.0-2.5? -30min -2
>2.5? -60min -4
CVVH order
? If non-heparin , N/S 200cc q 1/2 hr to rinse the AK
? Predilution run 500cc/hr alternately as followed via artery end
1st bottle N/S 500cc + Sinca 1amp
2nd bottle N/S 500cc + 10% MgSO4 4cc
3rd bottle N/S 500cc
4th bottle D5W 500cc + NaHCO3 5amp
? Warm dialysate to 37C
? Record I/O and BP q1hr
? UF target I-O () cc/hr
?Check BUN,Crea,Na,K,Cl,aPPT q6hr for 1 day & then q8hr.
? Check Ca,P,Mg qd.
CVVHD配置簡圖
CVVHD order
?Prepare Heparin 2cc + N/S 3cc, then inject 1.6cc into eachfemoral cath.
?For AK priming: (GAMBRO, Polyarylethersulfone, 6S)
*1st N/S 1000cc.
*2nd Heparin 2,500U.
*3rd N/S 500cc.
? *Prepare Heparin 25,000U + N/S 500cc IVD 10cc/hr with pump to keep aPPT 1.5-2? and adjust as followed:
aPPT bolushold dose(cc/hr)
<1.0? 2000U - +4
1.0-1.5? --+2
1.5-2.0? ---
2.0-2.5? -30min -2
>2.5? -60min -4
CVVHD order
? If non-heparin , N/S 200cc q 1/2 hr to rinse the AK
? 1.5% PD solution 500cc/hr run as dailysate
? Warm dialysate to 37C
? Record I/O and BP q1hr
? UF target I-O () cc/hr
?Check BUN,Crea,Na,K,Cl,aPPT q6hr for 1 day & then q8hr.
? Check Ca,P,Mg qd.
CVVHDF配置簡圖
CVVHDF
Continuous
Veno-Venous
Hemodiafiltration
CVVHDF order
?Prepare Heparin 2cc + N/S 3cc, then inject 1.6cc into eachfemoral cath.
?For AK priming: (GAMBRO, Polyarylethersulfone, 6S)
*1st N/S 1000cc.
*2nd Heparin 2,500U.
*3rd N/S 500cc.
? *Prepare Heparin 25,000U + N/S 500cc IVD 10cc/hr with pump to keep aPPT 1.5-2? and adjust as followed:
aPPT bolushold dose(cc/hr)
<1.0? 2000U - +4
1.0-1.5? --+2
1.5-2.0? ---
2.0-2.5? -30min -2
>2.5? -60min -4
CVVHDF order
? If non-heparin , N/S 200cc q 1/2 hr to rinse the AK
? Predilution run 500cc/hr alternately as followed via artery end
1st bottle N/S 500cc + Sinca 1amp
2nd bottle N/S 500cc + 10% MgSO4 4cc
3rd bottle N/S 500cc
4th bottle D5W 500cc + NaHCO3 5amp
? 1.5% PD solution 500cc/hr run as dailysate
? Warm predilution and dialysate to 37C
? Record I/O and BP q1hr
? UF target I-O () cc/hr
?Check BUN,Crea,Na,K,Cl,aPPT q6hr for 1 day & then q8hr.
? Check Ca,P,Mg qd.
CRRT
Continue Renal Replacement Therapy
Indications
Procedure共同處
?Driving force: external pump
? Circuit : Venovenous
? Dialysis solutions :一般使用1.5% PD solution
? Replacement fluid : several types of replacement fluid can be used , depending on patient requirements ,一般使用 pre-dilution 方式.
Anti-coagulation 的方式
? STANDARD HEPARIN
? TYPICAL REGIMEN IN CRRT :
? Priming of the circuit ( 5000 IU / L )
? Initial Heparin Bolus : 5 - 8 IU / kg
? Infuse Heparin at : 5 to 12 IU / kg / hr
? ACT on post filter : Adjust heparin rate to keep ACT between 1.5 & 2.0 times
STANDARD HEPARIN
LOW MOLECULAR WEIGHT (LMW) HEPARIN
? TYPICAL REGIMEN IN CRRT :
? Priming of the circuit : 20 mg in 1 L
? Maintenance dose : 10 to 40 mg q6 hrs
? Monitor anti- factor Xa (aXa) units . Adjust between 0.1 and 0.4 μ/ml
? Different Dosages for LMW heparin
LOW MOLECULAR WEIGHT (LMW) HEPARIN
Regional Citrate Anticoagulation
? TYPICAL REGIMEN :
? Citrate anticoagulation is always regional
? Citrate infusion (4%) at 170 ml/hr initially
? Special Dialysate at 1 liter/hr ( Na+ 117 ,K+ 4 , Mg++ 1.5 , Cl- 121.5 , dextrose 0.5- 2.5% , no Ca++ , no base )
? CaCL2 (0.75%) by central I.V at 40-60 ml/hr,? Maintain ionized Ca++ at 0.96- 1.20 mmol/L
Citrate
? ADVANTAGES :
? No Bleeding
? No Thrombocytopenia
? Improved Filter Life and Efficacy
Heparin- free methos
? Normal saline flush
? Used in patients with
1. Severe liver disease
2. Acitve or recent bleeding
3. Heparine-induced thrombocytopenia
4. Post-op patients
Dialysis modalities in the ICU
CVVH配置簡圖
CVVH order
?Prepare Heparin 2cc + N/S 3cc, then inject 1.6cc into eachfemoral cath.
?For AK priming: (GAMBRO, Polyarylethersulfone, 6S)
*1st N/S 1000cc.
*2nd Heparin 2,500U.
*3rd N/S 500cc.
? *Prepare Heparin 25,000U + N/S 500cc IVD 10cc/hr with pump to keep aPPT 1.5-2? and adjust as followed:
aPPT bolushold dose(cc/hr)
<1.0? 2000U - +4
1.0-1.5? --+2
1.5-2.0? ---
2.0-2.5? -30min -2
>2.5? -60min -4
CVVH order
? If non-heparin , N/S 200cc q 1/2 hr to rinse the AK
? Predilution run 500cc/hr alternately as followed via artery end
1st bottle N/S 500cc + Sinca 1amp
2nd bottle N/S 500cc + 10% MgSO4 4cc
3rd bottle N/S 500cc
4th bottle D5W 500cc + NaHCO3 5amp
? Warm dialysate to 37C
? Record I/O and BP q1hr
? UF target I-O () cc/hr
?Check BUN,Crea,Na,K,Cl,aPPT q6hr for 1 day & then q8hr.
? Check Ca,P,Mg qd.
CVVHD配置簡圖
CVVHD order
?Prepare Heparin 2cc + N/S 3cc, then inject 1.6cc into eachfemoral cath.
?For AK priming: (GAMBRO, Polyarylethersulfone, 6S)
*1st N/S 1000cc.
*2nd Heparin 2,500U.
*3rd N/S 500cc.
? *Prepare Heparin 25,000U + N/S 500cc IVD 10cc/hr with pump to keep aPPT 1.5-2? and adjust as followed:
aPPT bolushold dose(cc/hr)
<1.0? 2000U - +4
1.0-1.5? --+2
1.5-2.0? ---
2.0-2.5? -30min -2
>2.5? -60min -4
CVVHD order
? If non-heparin , N/S 200cc q 1/2 hr to rinse the AK
? 1.5% PD solution 500cc/hr run as dailysate
? Warm dialysate to 37C
? Record I/O and BP q1hr
? UF target I-O () cc/hr
?Check BUN,Crea,Na,K,Cl,aPPT q6hr for 1 day & then q8hr.
? Check Ca,P,Mg qd.
CVVHDF配置簡圖
CVVHDF
Continuous
Veno-Venous
Hemodiafiltration
CVVHDF order
?Prepare Heparin 2cc + N/S 3cc, then inject 1.6cc into eachfemoral cath.
?For AK priming: (GAMBRO, Polyarylethersulfone, 6S)
*1st N/S 1000cc.
*2nd Heparin 2,500U.
*3rd N/S 500cc.
? *Prepare Heparin 25,000U + N/S 500cc IVD 10cc/hr with pump to keep aPPT 1.5-2? and adjust as followed:
aPPT bolushold dose(cc/hr)
<1.0? 2000U - +4
1.0-1.5? --+2
1.5-2.0? ---
2.0-2.5? -30min -2
>2.5? -60min -4
CVVHDF order
? If non-heparin , N/S 200cc q 1/2 hr to rinse the AK
? Predilution run 500cc/hr alternately as followed via artery end
1st bottle N/S 500cc + Sinca 1amp
2nd bottle N/S 500cc + 10% MgSO4 4cc
3rd bottle N/S 500cc
4th bottle D5W 500cc + NaHCO3 5amp
? 1.5% PD solution 500cc/hr run as dailysate
? Warm predilution and dialysate to 37C
? Record I/O and BP q1hr
? UF target I-O () cc/hr
?Check BUN,Crea,Na,K,Cl,aPPT q6hr for 1 day & then q8hr.
? Check Ca,P,Mg qd.
附件资料：