CRRT

Nursing Management
General assessment

01 Contents
Cardiovascular Neurology
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02 Contents
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Respiratory Gastrointestinal
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03 Contents
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Renal 04 Contents Integument

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Initiation of • Assess and record the patient’s vital signs
and hemodynamic parameters prior to
initiation of therapy.
Therapy • Review physician orders and lab data
• Prepare vascular access using unit
protocol.
• Set fluid removal, dialysate and
replacement solution flow rates as
prescribed.
• Administer anticoagulant and initiate
infusion if applicable.
• Document patient’s hemodynamic
stability
with initiation of therapy.
 Intratherapy Monitoring
The critical care nurse must
continuously monitor the following
parameters during CRRT

• Blood pressure • Blood flow rate

• Patency of circuit • Ultrafiltration flow rate
• Hemodynamic stability • Dialysate/replacement flow
• Level of consciousness rate
• Acid/base balance • Alarms and responses
• Electrolyte balance
• Color of ultrafiltrate/filter
• Hematological status
blood leak
• Infection
• Color of CRRT circuit
• Nutritional status
• Air embolus
 The decision to terminate CRRT is made by the
nephrologist or an intensivist based on the
patient’s renal recovery or the patient’s status-
recovery or decision of the patient and family.
Termination • Extracorporeal circuit will be discontinued as
of Therapy per established protocol.
• Vascular access care administered as per
unit protocol
 Nurse Education
To ensure effective CRRT, nurses who care for patients
receiving this therapy should attend classes on this
specialized therapy and demonstrate clinical competency
on a regular basis.

Classes typically include education on :

 How To Use The CRRT Machine
 Identify Machine Alarms
 Perform Troubleshooting
 How much replacement

Ronco’s research
and dialysate do you use?
 Effects of different doses in CVVH on outcome of ARF - Ronco & Bellomo study. Lancet .
july 00

Ronco’s research
• Study:
• survival after 15 days
• recovery of renal function

306100135
 Evidenced Based Research reports that
patient survival is improved by:

Ronco’s research
• Early initiation:
• Utilization of RIFLE Criteria

• Minimum dose delivery of 35 ml/kg/hr

• eg. 70 kg patient = 2450 ml/h

Effects of different doses in CVVH on outcomes of ARF – C. Ronco M.D., R.

Bellomo M.D. Lancet 2000; 356:26-30.
The calculations :

SET FLUID BALANCE = Hourly Balance + Prescribed Fluid Removed

HOURLY INPUT = {( Hourly fluid intake × 24 ) + Fluids received in 24 hours} ÷ 24 Hours

HOURLY BALANCE = Hourly Input - Hourly Average Output

CALCULATING PARAMETERS
Contoh soal :

Tn X menggunakan CVP dengan Infus NaCL 0,9% 10 ml/jam,

Syringe pump Fentanyl (2000mcg dlm 100ml jalan 5 ml/jam,
midazolam infusion (100mg in 100ml jalan 5 ml/jam &
noradrenaline infusion (6mg in 100ml jalan 5ml/jam.
Enteral feeds jalan 80 ml/jam & pasien menerima rata-rata 200 mls
bolus cairan selama 24 jam.
Tidak ada Output dari pasien

CALCULATING PARAMETERS
Hourly input ={( Hourly fluid intake × 24 ) + Fluids received in 24 hours} ÷ 24 Hours
Hourly input = (((10 + 5 + 5 + 5 + 80) × 24) + 200) ÷ 24 = (((105) × 24) + 200) ÷
24 = (2520 + 200) ÷ 24 = 2720 ÷ 24 = 113 ml/jam

HOURLY BALANCE = Hourly Input - Hourly Average Output

Hourly balance = 113 – 0 = 113 ml/jam

SET FLUID BALANCE = Hourly Balance + Prescribed Fluid Removed

Set fluid balance = 113 ml/jam + 100 ml/jam = 213 ml/jam

CALCULATING PARAMETERS
Thank You