CRRT Priming Volume?

[rikkemp]

Just wondering what everyone does with the circuit priming volume on initiation of CRRT? We use the Fresenius 2008 for our CRRT. Historically we have not included this priming volume in our I & O or fluid calculation. The thought being that even though the patient has received approximately 250 ml of saline they are also having to adapt to having 250 ml of blood outside their body. Recently some dialysis techs have told our newer nurses that the priming volume must be included. They have experienced problems trying to get an additional 250 ml of fluid off in the first hour. Just wondering what the practice is in other places. Thanks for any feedback.

[pebbles, BSN, RN]

We are taught to try and take the priming volume off within the first few hours as long as the pt tolerates. We divide the volume between about three or four hours so you aren't taking it all off at once. I don't think there is official policy at my hospital on this though.

I personally don''t do so unless the goal of CRRT is fluid removal in general, then I can just add it in. But I agree with your rationale of yes, we instilled that volume of saline into the pt, but that volume worth of blood is now also outside of the pt. Our CRRT educator does discuss both theories with us and is comfortable to let us do what we feel is best for the specific patient.

[rikkemp]

Thanks for your response. It is such a help to hear how others approach different issues (especially with CRRT). It makes sense to me to leave this issue "flexible."