CRRT的临床应用与护理要点.ppt

* Post dilution fluid replacement ensures that the patient receives the total electrolyte/buffer concentration contained in the fluid. As with Pre-dilution administration of replacement solution, the volume of fluid used is what drives the convective clearance. The benefits received from pre-dilution replacement are not present with post-dilution replacement. Therefore there may be a need to increase anticoagulation to prevent filter clotting. A benefit that post-dilution replacement fluid does offer is that the effluent (UF) chemistries truly reflect the plasma solute losses and thus filter efficiencies. The UF vs. plasma chemistry value is an important measure of filter efficiency. (Discuss FUN/BUN ratios if desired.) * * * The following portion of the program is dedicated to discussing standards of clinical practice for continuous renal replacement therapy. This information can be found in the ANNA publication titled “Standards of Clinical Practice for Continuous Renal Replacement Therapy. This publication is also endorsed by the American Association of Critical Care Nurses (AACN). Various aspects of care will be presented. Guidelines for appropriate nursing interventions will be identified. * Patients referred to CRRT treatment are often very complicated presenting various etiologies that can be categorized in the areas shown here. It will be necessary to evaluate the patient in order to assure the patient will receive the appropriate therapy. We will review each of these areas individually. * So to summarize, let’s quickly compare and contrast the four basic CRRT therapies. SCUF is the most simple therapy, its purpose that of patient excess fluid removal. Blood enters the PRISMA extracorporeal circuit through an access line, passes through the hemofilter, and returns to the patient circulation via the return line. As the blood passes through the filter, ultrafiltration takes place and effluent collects in the effluent bag. Effluent is any fluid th