Lecture on Continuous Renal Replacement Therapy (CRRT)

Introduction

• Instructor: Eddie Watson
• Platform: ICU Advantage
• Series: Continuation on CRRT
• Focus: Understanding what CRRT is and its usage.

CRRT Overview

• CRRT stands for Continuous Renal Replacement Therapy.
• It is similar to intermittent hemodialysis (IHD) and peritoneal dialysis (PD).
• Designed for critically ill patients who cannot tolerate rapid fluid and electrolyte shifts.
• Unlike typical dialysis (3-4 hours), CRRT runs continuously for 24 hours.
• CRRT helps in removing toxins, excess fluid, and balancing electrolytes, mimicking kidney function.

Facilities and Alternatives

• Not all facilities offer CRRT.
• Alternative: SLED (Slow Low Efficient Dialysis) - 6-8 hour runs, daily.

Nursing and Operations

• Requires specialized nurses trained in CRRT and its physiological impacts.
• Typically, patients on CRRT require one-to-one staffing.

Indications for CRRT

• Used in critically ill, unstable patients with:
  • Acute Kidney Injury (AKI)
  • Acute kidney failure
  • End-stage renal disease
• Primary indications:
  • Elevated toxins (creatinine, BUN)
  • Fluid volume overload
  • Severe electrolyte imbalances
  • Acid-base imbalances
• Additional Uses:
  • Sepsis (cytokine clearance)
  • Rhabdomyolysis
  • Congestive Heart Failure (CHF)
  • Post open heart surgery
• CRRT allows for real-time adjustments in therapy.

Machine and Circuit Setup

• Machines:
  • Baxter Prismaflex / Prismax
  • Edwards Lifescience Aquarius
  • Next Stage
• Common setup uses Baxter Prismaflex.

Machine Components

• Access: Blood is removed and returned through a catheter (red for access, blue for return).

  • Catheters: 12 or 14 gauge, double lumen.
  • Veins: Internal jugular, subclavian, or femoral.

• Blood Pump: Roller pump

  • Creates negative pressure to draw blood; positive to filter it.
  • Blood flow rates: 150-300 ml/min.

• Filter: Contains hollow fiber membranes (blood flows from bottom to top).

• Deaeration Chamber & Safety Clamp: Removes air; prevents blood flow issues.

Fluids and Pumps

• Fluids: Pre-replacement, dialysate, post-filter replacement.
  • Pre-blood pump: Moves pre-replacement solution.
  • Dialysate: Flows top-to-bottom outside hollow fibers.
  • Effluent pump: Moves plasma water; collected in drainage bag.
  • Post-filter fluid: Mixed with blood after filtration.

Pressure Monitoring

• Monitors four pressures:
  • Access Pressure: Negative, for blood draw.
  • Pre-filter Pressure: Positive, through fibers.
  • Return Pressure: Positive, back to patient.
  • Effluent Pressure: Usually negative (sometimes slightly positive).

Conclusion

• CRRT setup can seem complex but essential for patient care.
• Further lessons will explore different therapies and machine operations.
• Feedback and support are appreciated; subscribers are encouraged.

---

Note

• Remember to subscribe and engage with the channel for more content on critical care education.
• Additional resources and support options are available through YouTube memberships and Patreon.