Another dialysis nurse told me this was being done in other parts of the country. Our protocol is to stop CRRT do the TPE then reset up the CRRT.
We also stop the CRRT for plasmaphoresis. Actually by that point that machine has usually clotted anyway and we just wait until after the TPE to resume the treatment. A couple of other issuses to bring up 1. I have never seen a 4 way stopcock. I work with 3 ways all the time but haven't seen a 4 way at work. 2. What machine do you use for CRRT? It could make a difference. We use the Fersenius which requires a separate r/o. It would be physically impossible to fit the R/O, dialysis machine and TPE machine into the same room with the pt, vent, IV pumps etc. The ICU nurse's and resp therapy already complain about climbing over machinery to get to the pt as it is. 3. How would the UFR be calculated while they are on TPE? The Red Cross does all of the TPE here and I am not totally familiar with it. I know it involves removing plasma and replacing it with large volumes of albumen but wouldn't that potentially cause hypovolemia or hypotension issuses to UF and plasma exchange at the same time? 4. How much more blood volume would be outside the body for the pt? Could the pt tolerate that additional loss even temporarily? If the dialysis filter clotted and the system was lost how would that affect the TPE treatment? Bottom line around here is that the pt's we do CRRT/SLED are to sick to tolerate much playing around. I tell families that dialysis is like doing metabolic areobics, CRRT is like a brisk walk. I would think TPE at the same time puts them back at the level of the metabolic areobics. If they can tolerate that then why not do conventional HD?