Gambro Prisma CRRT 7.1

Guest1030015 · Jul 2, 2017

Yes, we calculate I/Os and adjust fluid removal rate hourly to obtain the ordered net deficit. Sometimes the nephrologist orders "net positive," in which case we still calculate I/Os on a flow sheet but don't remove fluid. That said, there's some amount of clinical judgement involved. If I run a 250 ml piggyback during one hour, my patient might not tolerate pulling the full volume off in the following hour... I might take it off in a 2-3 hour period instead.

We have one machine on 7.1 and one on the old software, just to keep things super confusing for staff. The 7.1 software will provide hourly values for actual fluid removal, but it won't give you hourly amounts for dialysate, effluent, replacement, etc., like the older version did. Instead, the 7.1 software keeps a running total of these amounts. You could, in theory, continue to document this data hourly by subtracting the previous hour's total from the current hour, but it's a lot of busy work without any real benefit.

Our rep has also told us that the new software can't generate the hourly statistics. When using 7.1, we still document hourly I/Os, access/return and filter pressures, fluid removal rates and actual fluid removed. We used to calculate the other data manually when we first upgraded (e.g., subtract cumulative dialysate at 1400 from the cumulative number at 1500 to obtain an hourly number), but now we just record the cumulative values. Our nephrologists didn't care one way or the other when they were solicited for feedback.

MICURN5280 · Jul 28, 2017

Yes 7.1 gives the top of the hour fluid gain/removal. We use Epic and tally all I/Os q hour. You cant enter the intake of meds fluids etc in to the machine. If you give the pt fluid back by return ie CVVHDF mode than i think calculates the difference and reflects it in your hourly fluid gain/removal