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Renal Replacement Therapy

Renal Replacement Therapy - Renal Replacement Therapy Renal...

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Unformatted text preview: Renal Replacement Therapy Renal Trauma Conference 11-27-2006 Amanda Wheeler, MD Principles Principles 4 Main Modalities in ICU Main HD PD CVVH CVVHD Definition of Terms Definition SCUF- Slow Continuous Ultrafiltration CAVH- Continuous Arteriovenous CAVHHemofiltration Hemofiltration CAVH-D- Continuous Arteriovenous CAVH-DHemofiltration with Dialysis Hemofiltration CVVH- Continuous Venovenous CVVHHemofiltration Hemofiltration CVVH-D- Continuous Venovenous CVVH-DHemofiltration with Dialysis Hemofiltration Indications for Continuous Renal Replacement Therapy Replacement Volume Overload Electrolyte Imbalance Uremia Acid-Base Disturbances Drugs Hemodialysis vs Hemofiltration Membrane Membrane He m o d ia lys is m e m b ra ne s c o nta in lo ng , to rtuo us inte r­c o n ne c ting c h a n ne ls th a t re s ult in h ig h re s is ta nc e to fluid flo w. The hemofiltration membrane The hemofiltration consists of relatively straight channels of everstraight iincreasing diameter that ncreasing offer little resistance to fluid flow. fluid Hemodialysis allows the removal of water and solutes by diffusion across a concentration gradient. Hemodialysis Hemodialysis a d va nta g e s maximum solute clearance clearance best tx for severe hyper-K+ hyper-K+ ready availability ready limited anti-coagulation time time bedside vascular access access d is a d va nta g e s hemodynamic instability instability hypoxemia hypoxemia rapid fluid + solute shifts shifts complex equipment complex specialized personnel personnel Peritoneal Dialysis Peritoneal a d va nta g e s simple to set up + perform perform easy to use easy hemodynamic stability hemodynamic no anti-coagulation no bedside peritoneal access access d is a d va nta g e s unreliable ultrafiltration unreliable slow fluid + solute removal removal drainage failure, leakage leakage catheter obstruction catheter respiratory compromise respiratory hyperglycemia hyperglycemia peritonitis peritonitis CVVHD vs CVVH CVVHD CVVH CVVH 1. near-complete control of the rate of 1. fluid removal (i.e. the ultrafiltration rate) fluid 2. precision and stability 3. electrolytes or any formed element 3. of the circulation, including platelets or red or white blood cells, can be removed or added independent of changes in the volume of total body water water CVVH CVVH a d va nta g e s d is a d va nta g e s easy to use in ICU easy systemic rapid electrolyte correction rapid excellent solute clearances excellent rapid acid/base correction controllable fluid balance controllable tolerated by unstable patients patients early use of TPN early bedside vascular access routine routine anticoagulation * anticoagulation citrate anticoagulation new new frequent filter clotting frequent hypotension hypotension ...
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  • Fall '11
  • Dr.Aslam
  • Slow Continuous Ultrafiltration, CAVH- Continuous Arteriovenous, CAVH-D- Continuous Arteriovenous, CVVH- Continuous Venovenous

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