HLS2010

on our unit the nurses do most of the therapy the doctors say they want it and a general target in terms of fluid loss and then the nursing staff set it up, administer it and decide on exchange rates, pre and post dilution values, usually we only use CVVH but i have read a few articles suggesting CVVHD is also beneficial and am trying to see if it would be worth suggesting its implementation on the unit hence asking for advice on here.

our unit uses lung-protective ventilation aiming for a max of 6ml/kg tidal volumes on all patients unless contraindicated. we also use a mode of ventilation called APRV (airway pressure release ventilation) and since it's implementation and a greater awareness and knowledge we have reduced our need to prone or oscillate patients. we have good links to larger hospitals who provide ECMO as recent research has shown that this is preferable over oscillation.

there has recently been some debate in our unit about Continuous Renal Replacement Therapy (CRRT) Guidelines. Topics raised include; - which therapy is the most effective? CVVH / CVVHDF and why ? and should we have a protocol to decide which one to use ? - potassium supplementation and should we be using more formal guidelines / protocols when adding potassium to substitution bags to prevent hypokalemia ? - vascular access and what is best practice when line not in use hep-lock or citrate-lock ? - whether regular flushing of vascular access may prevent problems with access and return pressures during treatment ?