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