CRRT

Shanimal · Oct 11, 2018

Hard to know based on this information alone, but things that I would immediately suspect: the patient fluid removal rate has been on the low side for an extended period of time and/or the patient is hypercoagulable for whatever reason. Having a filter clot that often warrants a discussion with the nephrologist. Where I worked the CRRT orders were often adjusted to increase goal patient fluid removal (if tolerated and appropriate for the patient's need) and/or added anticoagulation, which was usually regionalized to the circuit using titrated sodium citrate paired with calcium gluconate replacement through the patient's IV access. Hope that helps some.

Triddin · Oct 12, 2018

Were you running anticoagulation with the run? If not, were you running any post filter replacement? Generally if the patient is clotting the filters once/shift it warrants a discussion if something needs to be changed

Cowboyardee · Oct 12, 2018

It would be good to know whether the pressure drop was also elevated and what type of settings you were using. An elevated TMP can be a sign of either clotting (small blood clots forming in your filter) or of clogging (larger particles that you are filtering out of the blood blocking the pores of your filter).

A high TMP along with a high pressure drop tend to indicate clotting. A particularly high TMP without as much of a concurrent rise in pressure drop is more often clogging. But be sure to look at the whole clinical picture to help determine whats going on in the patient.

Clotting might be dealt with by anticoagulating the patient or by changing some of your parameters (perhaps a higher pre-blood pump rate). Clogging, on the other hand, is often just a byproduct of the therapy doing what it's supposed to do on a patient who happens to have a lot of larger particles to filter (some kinds of sepsis" rhabdo, etc) - just change the filter more often to keep filtering effectively.