Very cool! Truly happy to be able to help!

Haha thank you! Maybe one day 😉

How cool! Hello in Malaysia Puteri! Glad you liked the series!

Yay so happy to hear this!

Yup! Unfortunately I can't go back and fix it. I tried to include the correct info in the lesson description.

Thank you so much! I'm sorry to hear that things are not setup well where you are when it comes to being able to effectively care for these patients. Protocols really make it easy to know what to do and can ensure consistency in care too. I will say I do love Citrate/Calcium combo. The first place I started doing CRRT was Heparin syringes, and I'm glad those days are over!

Awesome! glad you liked it!

Thank you so much. Too kind!

Hey, thank you Astrid. So the problem with the more practical videos is 2 part... 1) Having access to the equipment to be able to actually film things. Unfortunately I can't just go into the hospital and use the equipment for my own personal purpose. 2) These videos have a wide reach, not just around the US but around the world. I try and generalize as best I can on a lot of topics as some people use different equipment, but the same fundamentals apply. Hope that makes sense. I get the request. I just don't know if its best for this channel.

Awesome. Glad it was able to help cement the stuff you learned in class!

Very happy to hear this. Glad to be able to help!

Thanks for liking

So awesome Kathleen! Really glad you are liking them! :)

So glad to hear that you like it! :) So nice of you

You are welcome! Glad you are enjoying the series.

I enjoy teaching and sharing this info. Also great to hear its well received! Thank you!

Happy to hear!

You are very welcome. I'm glad to hear that you and others are enjoying them!

Awesome to hear this! You are very welcome.

So cool! Glad this video was able to help!

Awesome! 😊

Glad you liked it!

Thank you so much Lee!!

You're too kind!

Citrate is metabolized by the liver

As mention, citrate is metabolized by the liver. It becomes citric acid, H2O and bicarb. This can pose a problem is patients with cirrhosis and liver failure.

Awesome! So glad to hear this!

Thank you!! 😊

@@ICUAdvantageXOXO

Welcome

Not sure what you said, but with the thumbs up and heart I'll assume it was good 😊 So thank you lol

Ugh, I swear I also manage to fit at least one mistake in to every video! 🤦🏻‍♂️ Yup MG not GRAM! Unfortunately KZfaq doesn't have a way for me to insert a correction so I've added it to the description. Thanks for pointing that out and thanks for the ind words!

Yay!! So glad to hear this!

Yup! I've got that correction I had put in the video description, but yeah not sure what happened there!

Hey Karen, so the built in syringe delivers the heparin pre filter. Systemic anticoagulation would just be a regular heparin infusion you'd be giving to the patient like normal.

I would say just search around on the internet. There is a lot of good information out there about CRRT and even specifically Prismaflex and Prismax.

Correct, the dose goes down after 30 minutes. That said, while I have never run the regional anticoagulation setup with Heparin personally, I would imagine from what I've read on it that it is similar to the Citrate which is what I have my experience with. Our goal in regional is to not have any anticoagulation reach the patient (or minimal). It sounds as if, and I would imagine it to be as such, that the protamine is given via a continuous infusion either to the patient or via a y-connector with the returning blood. This rate would be adjusted based on the rate of the heparin infusion being given via y-connector to the blood at the access line.

@@ICUAdvantage it should read mg not grams

Too kind! I really appreciate you and glad you liked it!

Great question. In my experience, its usually only if there is so contraindication to continuing the citrate and/or anticoagulation. Bleeding, hypernatremia not corrected with changes to replacement fluid. But we stop therapy with citrate running all the time.

Haha yeah, its a little excessive. Slip of the tongue which I had corrected in the video description when it was first noticed.

Yup. Slip of the tongue and corrected in video description.

I don't know if I have a good answer to that. I typically see the dialysate running at about 1.5-2x that of both the pre and post combined. 500 pre, 1500 dialysate, 500 post is a common ratio.

Honestly its been a while since I've used heparin for anticoagulation for CRRT. As for the runs, we've had people run MUCH longer than 5 days straight.

@@ICUAdvantage Watched the anticoagulant video. For an average 70kg what will be the dose of citrate and calcium you would need For CRRT CVVHDF how do you calculate the fluid balance. Do you do both pre filter and post filter fluid replacement at the same time? How will you tranafuse blood and give drugs with a patient on CRRT? Do you need to increase vasopressor dose and antibiotics? Which filter will you prefer to use? Is it the intensivist or nephrologist that is in charge of ICU CRRT in your center and country?

Great question. I think there can be a lot at play here. Certainly we are starting CRRT as the kidneys are failing so a good part is just them reaching that point. Certainly the decreased concentration gradients play a role as they help drive the functioning of cells in the nephrons and ducts. I also think decreasing fluid volume also plays a role. But as they start recovering, even with CRRT going we start to see them increasing urine output. As for your hepatic failure, we’re you pulling fluid at all or running them even? If not pulling excess fluid, and having functioning kidneys, I’d expect them to continue making urine as before.

@@ICUAdvantage thanks for replying.

I've never seen a set primed with heparin, but 5000u could certainly be an issue for someone with bleeding risks. We typically don't anticoagulate those with bleeding risks.