Continuous Renal Replacement Therapy (CRRT) - Overview Types of CRRT • CVVHD - Continuous Veno-Venous hemodialysis - Diffusion requires dialysate fluid • CVVH - Continuous Veno-Venous Hemofiltration - Convection requires replacement fluid • CVVHDF - Continuous Veno-Venous Hemodiafiltration - Diffusion + convection require dialysate + replacement fluid Emergent dialysis indications can be remembered by AEIOU: A: acidosis (severe) E: electrolytes (essentially hyperkalemia) I: intoxication (SLIME - salicylates, Li+, isopropanol, methanol, ethylene glycol) O: overload (volume overload; diuretic refractory) U: uremia (encephalopathy — most common, uremic bleeding. uremic pericarditis) CRRT Specific Indications: • AKI or ESRD with hemodynamic instability • Continuous volume control, solute control and/or or toxin clearance • Post-head trauma, intracranial bleed. and some neurosurgical procedures Access: • R IJV - preferred; 15-20cm catheter (most pts need 20cm. based on height) • L IJV - ↑ risk catheter malfunction; 20-24cm catheter (most pts need 24cm) • Femoral Vein - ↑ risk of infection in pts with ↑ BMI; 24-30cm catheter Dose: • Typical dialysis dose = 20-25 mL/kg/hr • ↑ dose = removal of solutes + ↑ rapid correction of metabolic disturbances • Basic bath with citrate: 4K or 2K (both with O Ca; remember. Ca drip running peripherally) • Basic bath without citrate: 4K, 2K, or 0K (all with 2.5 Ca) - Dr. Meredith Greer @EmmGeezee #Continuous #Renal #Replacement #Therapy #CRRT #Overview #Indications #Nephrology #Management
