Flux networks draining everything9/9/2023 ![]() Fluid removal could not be regulated, with effluent flow determined by the patency of the filter, the arterial-venous blood pressure gradient and the distance between the filter and the effluent collection bag. These arterial-venous CRRT circuits were fraught with challenges. Early CRRT circuits required arterial and venous access devices (called Continuous Arterial-Venous circuits), as the arterial-venous blood pressure gradient was used to drive blood flow through the circuit. In the 1960's - 1970's, surgically implanted external arterial-to-venous shunts (e.g., Scribner, or Thomas shunts) were used for acute dialysis access. Historically, early dialysis circuits required the removal of blood from an artery with return of the "cleaned" blood to a vein. CRRT is delivered using sterile fluids, therefore, solutions can be delivered as either dialysis fluid or as replacement fluids into the blood path. In CCTC, CRRT is provided using a Baxter PrisMaxTM or PrismaFlexTM machine. IHD and SLEDD require an IHD and an RO machine and are only run by IHD trained nurses at London Health Sciences Centre. ![]() Dialysate fluid is not IV sterile, therefore, it cannot be delivered into the blood path. Intermittent hemodialysis and SLEDD are both delivered using a conventional hemodialysis machine that creates dialysis fluid (called dialysate) by adding electrolytes and salts to city water that has been dechlorinated and purified using reverse osmosis (RO). Hemodynamic stability usually determines the method. RRT for either group may be provided using either IHD or CRRT. While intermittent dialysis allows chronic renal failure patients to limit the amount of time that they are connected to a machine, the rapid clearance of solutes and fluid can be poorly tolerated when a patient is hemodynamically unstable.ĭuring an acute illness, patients with ESRD often require more frequent renal replacement therapy to manage their increased production of metabolic by-products. Patients who develop Acute Kidney Injury that does not resolve with shock management may also require acute renal replacement therapy. Intermittent hemodialysis removes large amounts of water and wastes in a short period of time (usually over 2-4 hours), whereas, continuous renal replacement therapies remove water and wastes at a slow rate more consistent of that of native renal function. The major difference between intermittent and continuous therapies is the speed at which water and wastes are removed. The filter performs many of the functions of the kidney's nephron unit, hence, it is referred to as an "artificial kidney". Blood is removed from the patient, pumped through a dialysis filter and returned to the patient following removal of surplus water and wastes. Most critically ill patients who need Renal Replacement Therapy (CRRT) will receive either IHD or Continuous Renal Replacement Therapy (CRRT). Both intermittent hemodialysis and continuous hemodialysis circuits utilize the same principles. ![]() It will be run by a dialysis nurse who is trained in PD. Patients who are receiving peritoneal dialysis who are stable may have PD continued in the critical care unit. ![]() Peritoneal dialysis is rarely used in critical care. CCPD requires patients to connect to a machine (usually at night) for automated exchanges. In CAPD, patients can administer and manage passive exchanges 3-5 times per day. Peritoneal dialysis can be provided as Continuous Ambulatory Peritoneal Dialysis (CAPD) or Continuous Cycling Peritoneal Dialysis (CCPD). Chronic IHD is usually provided 2-4 days per week (depending upon the type of renal dysfunction). Chronic dialysis is provided either using Intermittent Hemodialysis (IHD) or Peritoneal Dialysis. End-Stage Renal Disease (ESRD) refers to kidney disease that has resulted in the permanent destruction of a sufficient number of nephron units that renal function (waste and/or water removal) must replaced using an artificial kidney (Renal Replacement Therapy). ![]()
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