CRRT question

[gizdo]

Our facility has just started using CRRT in the past couple of weeks. We are having a huge debate amongst each other about how to calculate the patients fluid balance. Our educators insist that we just take the total fluid removed off the prismaflex and then subtract any other losses or gifts (ie pleural tubes or boluses) and that is our balance.

However, everyone else is thinking that we have to subtract our intake from our fluid removed to get a true patient fluid balance.

So far with the existing calculation we are getting a fluid removal of around 3 to 8 Liters for every 12 hour period. This seems really excessive, but we are told that it is correct. How can this be correct when we are supposed to be taking off around 600mls of fluid per shift?

Can anyone share how their facility calculates the 24 hour fluid balance?

Thanks!

[Go UT Vols]

Thanks everyone for your input. Just to clarify we do not record hourly set prisma volumes (i.e. replacement, dialysate, etc.). But unfortunately we also do not have a standardized formula for calculating hourly fluid removal rates. I think most of the concern is that many people do not believe you need to take into account your current removal rate to calculate the next hours rate (at the top of the hour), while others, like myself, think it has to be a factor in your calculations in order to obtain a cumulative shift targetted removal rate. Unfortunately we are still the blind leading the blind and our physicians are Trauma Surgeons not Nephrologist when this therapy is implemented which adds to the confusion (seems wiser to consult an expert in the field but that's a whole other thread!!)

[WindwardOahuRN, RN]

Thanks everyone for your input. Just to clarify we do not record hourly set prisma volumes (i.e. replacement, dialysate, etc.). But unfortunately we also do not have a standardized formula for calculating hourly fluid removal rates. I think most of the concern is that many people do not believe you need to take into account your current removal rate to calculate the next hours rate (at the top of the hour), while others, like myself, think it has to be a factor in your calculations in order to obtain a cumulative shift targetted removal rate. Unfortunately we are still the blind leading the blind and our physicians are Trauma Surgeons not Nephrologist when this therapy is implemented which adds to the confusion (seems wiser to consult an expert in the field but that's a whole other thread!!)

"YIKES" to a nephrologist not being on board with CRRT. There is a bit of (nephrology) art to the decisions regarding replacement and dialysate fluids, electrolyte replacement, etc. Most times we use PRISMASATE for replacement and dialysate fluids (often different solutions, though)---soooo much better than the olden days where we had to mix MgSO4, K, NaHCO3, and CA into liter bags of fluid. Wooohooo for progress.

And yes, you certainly DO have to take into account the removal rates that were set into the PRISMA and the difference between the actual fluid removed when you calculate your next hour's removal rate.

If you don't you could conceivably just snowball from hour to hour and end up way off your fluid removal goal.

Pardon me but this sounds like quite a mess....