CRRT question - page 2
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... Read More
Oct 5, '09Specialty: Critical Care ; Joined: Oct '05; Posts: 295; Likes: 198Quote from Go UT Vols"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.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!!)
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....