Kimberlee Spurlin, RN lectures and discusses the use of Continuous Renal Replacement Therapy (CRRT) and Continuous Veno Venous Hemofiltration (CVVH) integrated into the ECMO circuit. CRRT fundamentals.
Extracorporeal Membrane Oxygenation Indication for CRRT:
Renal Replacement: – Hyperkalemia – Acidemia – Pulmonary Edema – Regulation of acid – base and electrolyte imbalances
Renal Support: – Fluid removal in CHF – Cytokine manipulation in sepsis – Treatment of respiratory acidosis in ARDS – Fluid management in multi system organ failure CRRT.
MODES OF THERAPY:
SCUF – Slow continuous ultrafiltration. Primary goal is volume removal.
CVVH – Continuous Veno Venous Hemofiltration. Primary goal is to achieve small, medium and large molecule clearance (convective) and remove patient fluid.
CVVHD – Continuous VenoVenous Hemodialysis. Primary goal is to achieve small molecule clearance (diffusive) and remove patient fluid.
CVVHDF – Continuous Venovenous Hemodiafiltration. Primary goal is to achieve small, medium and large molecule clearance (convection and diffusion) and remove patient fluid.
Hemofilter structure and function.
Diffusion – dialysis uses a semipermeable membrane for selected diffusion. Movement of Solutes from an area of higher concentration to an area of lower concentration.