Continuous Renal Replacement Therapy

Continuous Renal Replacement Therapy Jai Radhakrishnan, MD, MS. History of the CRRT program 1988. Open heart program Active transplant program Deep dissatisfaction with peritoneal dialysis in hemodynamically unstable patients Objectives Physiologic principles Patient Selection for CRRT. Modality Selection Prescription Variables Fluid Composition Management of Fluid and Electrolyte problems Controversies Basic Concepts Pressure Convection (Plasma water moves along pressure gradients). Continuous Renal Replacement Therapy SCUF. CVVH. CVVHD. CVVHDF. Therapy Options Access Return SCUF: Slow P. R. I. S. Continuous M. A. Ultra Filtration Maximum Patient Fluid Removal Effluent Rate = 2000 ml/hr Therapy Options Access Return CVVH. Continuous P. R. Veno-Venous I. S. M. A. Replacement HemoFiltration Effluent Maximum Patient Fluid Removal Rate = 1000 ml/hr Therapy Options Access Dialysate Return CVVHD.

Continuous Renal Replacement Therapy ... Anticoagulation Heparin 250 - 500 U/hr HIT: Argatroban 0.5 - 1 mg/hr Bleeding risk: Citrate No anticoagulation. Argatroban CRRT Anticoagulation Protocol 1. Call Hematology for approval. 2. In a 20 cc syringe (1000 mcg/mL): 30 microgram/kg/hr (0.5 microgram/kg/min) ...

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  Replacement, Learn, Continuous, Anticoagulation, Continuous renal replacement, Argatroban

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