I was taking care of patient who is under CVVHDF. I am new at it and want to share to improve. Thanks.
The 57 year old man was initially admitted for DKA, sepsis, chronic renal failure. Was ventilated and had his medical condition corrected. After extubated and transfer to medical ward, he was found later have hidden abscess at his Rt thigh, and drug-induced abnormal LFT- undergone op and came back to ICU and ventilated overnight. His BP dropped, given blood products, commerced inotrops and CVVFDF with zero extraction. Extubated the next day and on o2 FM.. The first post-op day, UF started at 50, then increased to 80 due to postive balance thousand plus with no unrine output and the BP is stablized. Input is 1L perday plus IV med. Predictably, he was shown to have hypoalbuminemia with anasarca. Third day with wheezing, put on HFM o2 12L, started prn Neb and increased UF to 120. The BP and CVP gradually came down with constant dopamine support and thus UF cut down to 100. As through out the few hours of removal of fluid, the wheezing and his upper limbs edema subsided.
Question here :
1. He was always hypothermic 34c due to the CVVHDF..
-but he is not complaining of it cold or any sort. Why?
-Should I put warmer-blanket for him? Why?
-The orthopedic surgeon doesn't want us to involve warming the surgical site. Why?
Surgeons dislike hypothermia because it can increase bleeding issues. Clinically relevent hypothermia (generally defined as less than 35 degrees Celsius) can mimic severe clotting factor deficiencies. Of course, the lower it goes, the worse it will get. Couple this with the anticoagulant used in the circuit and you could have some trouble. It sounds like your patient was just scraping by on the temperature front.
It is not uncommon for CRRT patients to have dialysis-induced hypothermia. At our facility, it is fairly usual to have these patients under lights and a Bair Hugger.
Knowing that hypothermia is common for these patients should also make you very wary of fever. If the dialysis can lower the core temp by two degrees, you can picture what the patient's actual response is if his temperature is reading 37.7!
Last edit by -MNC_RN- on Apr 22, '08