Page 142 - Critical Care Notes

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■ Assess breath and heart sounds.
■ Monitor ECG for arrhythmias.
■ Assess for disequilibrium syndrome: restlessness, ↓ LOC, headache, muscle
twitching, and seizures, and stop dialysis if necessary.
■ Many drugs are dialyzable. Medications may be held during dialysis.
■ Vasoactive drugs can cause hypotension → may be held until after dialysis.
■ Antibiotics may be given after dialysis and administered on days patients
receive dialysis.
Postdialysis Care
■ Monitor vital signs every hour × 4 hr, then every 4 hr (hypotension may
occur secondary to hypovolemia thus requiring IV fluids; ↑ temperature
may occur after dialysis secondary to blood warming mechanism of the
hemodialysis machine).
■ Weigh after dialysis.
■ Monitor vascular access site for bleeding.
■ Assess fistula or graft for bruit and thrill (“hear the bruit and feel the thrill”).
■ Avoid all invasive procedures for 4–6 hr after dialysis if anticoagulation used.
Continuous Renal Replacement Therapy (CRRT)
CRRT represents a family of modalities that provide continuous support of
severely ill patients in AKI. It is used when hemodialysis is not feasible. CRRT
works more slowly than hemodialysis and requires continuous monitoring. It is
indicated for patients who are no longer responding to diuretic therapy, are in
fluid overload, and/or are hemodynamically unstable.
Procedure
CRRT requires placement of a continuous arteriovenous hemofiltration (CAVH)
catheter or continuous venovenous hemofiltration (CVVH) catheter and a mean
arterial pressure of 60 mm Hg.
Other types of CRRT include:
■ Continuous arteriovenous hemodialysis (CAVHD)
■ Continuous venovenous hemodialysis (CVVHD)
■ Slow continuous ultrafiltration (SCUF)
■ Continuous arteriovenous hemodiafiltration (CAVHDF)
■ Continuous venovenous hemodiafiltration (CVVHDF)
Because it is difficult to obtain and maintain arterial access, CVVH or venous
access is preferred.
CRRT provides for the removal of fluid, electrolytes, and solutes.
CRRT differs from hemodialysis in the following ways:
■ It is continuous rather than intermittent, and large fluid volumes can be
removed over days instead of hours.
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