Continuous renal replacement therapy and ICU dialysis concepts for the critical care nurse, distinct from the hemodynamics and ventilator critical care decks.
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- What does CRRT stand for?
- Continuous renal replacement therapy.
- What is the primary goal of CRRT in a hemodynamically unstable ICU patient?
- To slowly and continuously remove fluid and solutes without causing large hemodynamic swings.
- What solute removal process does CVVH (continuous venovenous hemofiltration) rely on?
- Convection.
- What solute removal process does CVVHD (continuous venovenous hemodialysis) rely on?
- Diffusion.
- What does CVVHDF combine?
- Both convection and diffusion (hemofiltration plus hemodialysis).
- In convective clearance, solutes move across the CRRT filter membrane by a process called ____.
- solvent drag
- In diffusive clearance, solutes move across the membrane along what type of gradient?
- A concentration gradient.
- What fluid flows countercurrent to blood in CVVHD to create a diffusion gradient?
- Dialysate.
- What is the fluid called that is discarded after passing through the CRRT filter?
- Effluent.
- What type of vascular access is typically used for CRRT?
- A large-bore dual-lumen central venous catheter.
- Name two common insertion sites for a CRRT dialysis catheter.
- Internal jugular vein and femoral vein.
- What is the typical blood flow rate range used during CRRT?
- About 100 to 200 mL/min.
- What baseline labs should be checked before initiating CRRT?
- Electrolytes and renal function values, such as BUN, creatinine, and potassium.
- What is the most common anticoagulant strategy used to prevent clotting in the CRRT circuit?
- Regional citrate anticoagulation.
- How does citrate anticoagulation prevent clotting in the CRRT circuit?
- It chelates (binds) ionized calcium in the extracorporeal circuit, inhibiting the clotting cascade.