Renal Replacement Therapy In Critical Care

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odium chloride 0.9%)Justification (Rationale)This leads to some heparin ‘sticking’ tothe haemofilter and tubing so helping toprolong the circuit lifeNote: Do not prime filter with heparinised saline if thereis concern regarding heparin inducedthrombocytopenia.Fill a 20ml syringe with 20mls of 0.9% sodium chlorideSet the anticoagulation rate to 0mls/hourNo anticoagulation will be delivered butthe Prismaflex still requires that thesyringe be filled and loaded correctlyE: Epoprostanol AnticoagulationRecommendation (Action)The Prismaflex circuit should be primed withheparinised sodium chloride 0.9% (5000units heparinsodium in 1L sodium chloride 0.9%)Justification (Rationale)This leads to some heparin ‘sticking’ tothe haemofilter and tubing so helping toprolong the circuit lifeNOTE: Do not prime filter with heparinised saline ifthere is concern regarding heparin inducedthrombocytopenia.Fill a 20 ml syringe with 20mls epoprostenol [Flolan ]Run at 2.5nanogram/kg/minutePlease refer to electronic prescriptionand product insert with regards todilution of drugA low dose is used as epoprostenol cancause marked reduction in bloodpressure and cardiac outputRenal Replacement Therapy in Critical Care (2013) dated 06 Sep 1311

7.TRAINING REQUIREMENTSThis guideline should be read in conjunction with the ICU Renal Handbook. All Critical Care staffwill be informed of the content of this guideline and how to access it via the Critical CareGuidelines and SOPs intranet page. All staff involved in prescribing and delivering RRT will begiven appropriate training, managed by the Critical Care Education Team and Renal Team. Alaminated summary of this guideline will be attached to all haemofiltration machines.8.MONITORING COMPLIANCE WITH, AND THE EFFECTIVENESS OF,PROCEDURAL DOCUMENTSThis guideline will be reviewed initially at 6 months and thereafter 2 yearly by the Critical CareGovernance Group. Measurement of compliance will be achieved by unit-based audit. Resultsreviewed will be fed back to members of the senior medical /nursing team and the Critical CareGovernance Group.9.REFERENCES AND ASSOCIATED DOCUMENTATIONPalevsky PM et al. Intensity of renal support in critically ill patients withacute kidney injury. N Engl J Med 2008; 359:7-20 [ATN study]Bellomo R et al. Intensity of continuous renal replacement therapy in critically ill patients. N Engl JMed 2009; 361:1627-1638 [RENAL study]Jun M et al. Intensities of renal replacement therapy in acute kidney injury: A systematic reviewand meta-analysis. Clin J Am Soc Nephrol 2010; 5: 956-963 [Meta-analysis 1]Van Wert R et al. High-dose renal replacement therapy for acute kidney injury: Systematic reviewand meta-analysis. Crit Care Med 2010; 38 (5): 1360-9 [Meta-analysis 2]Uchino S, Fealy N, Baldwin I et al. Continuous venovenous haemofiltration without anticoagulation.ASAIO J 2004; 50:76-80Oudemans-van Straaten HM, Wester JPJ, de Pont ACJM et al. Anticoagulation strategies incontinuous renal replacement therapy: can the choice be evidence based? Intensive Care Med2006; 32:188-202Baldwin I, Bellomo R, Koch W. Blood flow reductions during continuous renal replacement therapyand circuit life. Intensive Care Med 2004; 30: 2074-2079Oudemans-van Straaten HM, Kellum JA, Bellomo R. Clinical review: Anticoagulation forcontinuous renal replacement therapy – heparin or citrateIntensive Care Society Standards for Renal Replacement menuid 7Renal association guidelines for management of /AcuteKidneyInjury.aspx#downloadsPlease refer to Renal Handbook available via DCCQ website for a comprehensive list ofreferences and further reading.Renal Replacement Therapy in Critical Care (2013) dated 06 Sep 1312

Appendix AChecklist for the Review and Ratification of Procedural Documents andConsultation and Proposed Implementation PlanTo be completed by the author of the document and attached when the document is submitted

Renal Replacement Therapy in Critical Care Aim: To provide guidance on the choice of modality and delivery of renal replacement therapy (RRT) on the ICU. Scope: All adult patients on the Intensive Care Unit who need renal replacement therapy Choice of mode CVVH 35mls/kg/hour CVVHDF 35mls/kg/hour Prescripti

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Renal Replacement Therapy in Critical Care Aim: To provide guidance on the choice of modality and delivery of renal replacement therapy (RRT) on the ICU. Scope: All adult patients on the Intensive Care Unit who need renal replacement therapy Choice of mode CVVH 35mls/kg/hour CVVHDF 35mls/kg/hour Prescription Effluent production: use mls/kg/hour effluent as above

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