【持续性肾脏替代治疗crrt英文精品课件】crrt protocol

《【持续性肾脏替代治疗crrt英文精品课件】crrt protocol》由会员上传分享，免费在线阅读，更多相关内容在教育资源-天天文库。

CRRTContinueRenalReplacementTherapyCVVHCVVHDCVVHDF IndicationsIncriticallyillpatientswithrenalfailureandhemodynaemicinstabilityForpatientsinwhomcontinuousremovalofvolumeortoxicsubstanceisdesirable(asinsepticshock,AMI,severeGIbleeding,ARDSorconditionwithoratriskforcerebraledema….) Procedure共同處Drivingforce:externalpumpCircuit:VenovenousDialysissolutions:一般使用1.5%PDsolutionReplacementfluid:severaltypesofreplacementfluidcanbeused,dependingonpatientrequirements,一般使用pre-dilution方式. Anti-coagulation的方式STANDARDHEPARINTYPICALREGIMENINCRRT:Primingofthecircuit(5000IU/L)InitialHeparinBolus:5-8IU/kgInfuseHeparinat:5to12IU/kg/hrACTonpostfilter:AdjustheparinratetokeepACTbetween1.5&2.0times STANDARDHEPARINADVANTAGESEasytoperformUsefulmethodInexpensiveDISADVANTAGESOccasionalThrombocytopeniaHemorrhagicRiskwithBleedingpatient LOWMOLECULARWEIGHT(LMW)HEPARINTYPICALREGIMENINCRRT:Primingofthecircuit:20mgin1LMaintenancedose:10to40mgq6hrsMonitoranti-factorXa(aXa)units.Adjustbetween0.1and0.4µ/mlDifferentDosagesforLMWheparin LOWMOLECULARWEIGHT(LMW)HEPARINADVANTAGESDecreasedRiskofBleedingDISADVANTAGESExpensiveSpecialanddifficultmonitoringWithlowdosesfrequentfilterclotting RegionalCitrateAnticoagulationTYPICALREGIMEN:CitrateanticoagulationisalwaysregionalCitrateinfusion(4%)at170ml/hrinitiallySpecialDialysateat1liter/hr(Na+117,K+4,Mg++1.5,Cl-121.5,dextrose0.5-2.5%,noCa++,nobase)CaCL2(0.75%)bycentralI.Vat40-60ml/hr,MaintainionizedCa++at0.96-1.20mmol/L CitrateADVANTAGES:NoBleedingNoThrombocytopeniaImprovedFilterLifeandEfficacyDISADVANTAGES:ComplexforthesetupCa++monitoringneededOccasionalAlkalosis Heparin-freemethosNormalsalineflushUsedinpatientswith1.Severeliverdisease2.Acitveorrecentbleeding3.Heparine-inducedthrombocytopenia4.Post-oppatients DialysismodalitiesintheICU CVVH配置簡圖CVVHContinuousVeno-VenousHemofiltrationPRISMACVVH模式下,置換液流速最高可達4500ml/hr CVVHorderlPrepareHeparin2cc+N/S3cc,theninject1.6ccintoeachfemoralcath.lForAKpriming:(GAMBRO,Polyarylethersulfone,6S)*1stN/S1000cc.*2ndHeparin2,500U.*3rdN/S500cc.l*PrepareHeparin25,000U+N/S500ccIVD10cc/hrwithpumptokeepaPPT1.5-2andadjustasfollowed:aPPTbolusholddose(cc/hr)<1.02000U-+41.0-1.5--+21.5-2.0---2.0-2.5-30min-2>2.5-60min-4 CVVHorderIfnon-heparin,N/S200ccq½hrtorinsetheAKPredilutionrun500cc/hralternatelyasfollowedviaarteryend1stbottleN/S500cc+Sinca1amp2ndbottleN/S500cc+10%MgSO44cc3rdbottleN/S500cc4thbottleD5W500cc+NaHCO35ampWarmdialysateto37CRecordI/OandBPq1hrUFtargetI-O()cc/hrCheckBUN,Crea,Na,K,Cl,aPPTq6hrfor1day&thenq8hr.CheckCa,P,Mgqd. CVVHD配置簡圖CVVHDContinuousVeno-VenousHemodialysisPRISMAS CVVHDorderlPrepareHeparin2cc+N/S3cc,theninject1.6ccintoeachfemoralcath.lForAKpriming:(GAMBRO,Polyarylethersulfone,6S)*1stN/S1000cc.*2ndHeparin2,500U.*3rdN/S500cc.l*PrepareHeparin25,000U+N/S500ccIVD10cc/hrwithpumptokeepaPPT1.5-2andadjustasfollowed:aPPTbolusholddose(cc/hr)<1.02000U-+41.0-1.5--+21.5-2.0---2.0-2.5-30min-2>2.5-60min-4 CVVHDorderIfnon-heparin,N/S200ccq½hrtorinsetheAK1.5%PDsolution500cc/hrrunasdailysateWarmdialysateto37CRecordI/OandBPq1hrUFtargetI-O()cc/hrCheckBUN,Crea,Na,K,Cl,aPPTq6hrfor1day&thenq8hr.CheckCa,P,Mgqd. CVVHDF配置簡圖CVVHDFContinuousVeno-VenousHemodiafiltrationPRISMAS CVVHDForderlPrepareHeparin2cc+N/S3cc,theninject1.6ccintoeachfemoralcath.lForAKpriming:(GAMBRO,Polyarylethersulfone,6S)*1stN/S1000cc.*2ndHeparin2,500U.*3rdN/S500cc.l*PrepareHeparin25,000U+N/S500ccIVD10cc/hrwithpumptokeepaPPT1.5-2andadjustasfollowed:aPPTbolusholddose(cc/hr)<1.02000U-+41.0-1.5--+21.5-2.0---2.0-2.5-30min-2>2.5-60min-4 CVVHDForderIfnon-heparin,N/S200ccq½hrtorinsetheAKPredilutionrun500cc/hralternatelyasfollowedviaarteryend1stbottleN/S500cc+Sinca1amp2ndbottleN/S500cc+10%MgSO44cc3rdbottleN/S500cc4thbottleD5W500cc+NaHCO35amp1.5%PDsolution500cc/hrrunasdailysateWarmpredilutionanddialysateto37CRecordI/OandBPq1hrUFtargetI-O()cc/hrCheckBUN,Crea,Na,K,Cl,aPPTq6hrfor1day&thenq8hr.CheckCa,P,Mgqd.