Continuous Renal Replacement Therapy (CRRT) - Overview

Types of CRRT

 • CVVHD - Continuous Veno-Venous hemodialysis - Diffusion requires dialysate fluid

 • CVVH - Continuous Veno-Venous Hemofiltration - Convection requires replacement fluid

 • CVVHDF - Continuous Veno-Venous Hemodiafiltration - Diffusion + convection require dialysate + replacement fluid

Emergent dialysis indications can be remembered by AEIOU:

  A: acidosis (severe)

  E: electrolytes (essentially hyperkalemia)

  I: intoxication (SLIME - salicylates, Li+, isopropanol, methanol, ethylene glycol)

  O: overload (volume overload; diuretic refractory)

  U: uremia (encephalopathy — most common, uremic bleeding. uremic pericarditis)

CRRT Specific Indications:

 • AKI or ESRD with hemodynamic instability

 • Continuous volume control, solute control and/or or toxin clearance

 • Post-head trauma, intracranial bleed. and some neurosurgical procedures

Access:

 • R IJV - preferred; 15-20cm catheter (most pts need 20cm. based on height)

 • L IJV - ↑ risk catheter malfunction; 20-24cm catheter (most pts need 24cm)

 • Femoral Vein - ↑ risk of infection in pts with ↑ BMI; 24-30cm catheter

Dose:

 • Typical dialysis dose = 20-25 mL/kg/hr

 • ↑ dose = removal of solutes + ↑ rapid correction of metabolic disturbances

 • Basic bath with citrate: 4K or 2K (both with O Ca; remember. Ca drip running peripherally)

 • Basic bath without citrate: 4K, 2K, or 0K (all with 2.5 Ca)



- Dr. Meredith Greer @EmmGeezee



#Continuous #Renal #Replacement #Therapy #CRRT #Overview #Indications #Nephrology #Management