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Anticoagulation for CRRT - CRRT Explained! 

ICU Advantage
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In this fifth lesson, we are talking anticoagulation for CRRT! I cover quickly why we use anticoagulation, and then get in to talking about our different anticoagulation strategies. These consist of no anticoagulation, systemic anticoagulation, and regional anticoagulation.
❗️❗️CORRECTION: 100u Heparin = 1mg of Protamine (not 1g)❗️❗️
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0:00 Intro
1:07 Why?
2:12 Strategies
2:30 None
3:29 Systemic
5:06 Regional
11:14 Conclusion
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Check out these other great lessons and series of lessons below!
✅ Hemodynamics: • Hemodynamic Principals
✅ Shock: • Shock
✅ ECG/EKG Rhythm Interpretation: • ECG/EKG Interpretation
✅ ICU Drips: • ICU Drips
✅ ECMO: • ECMO
✅ CRRT: • CRRT Explained!
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#ICUAdvantage #CRRT #Nursing

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3 июл 2024

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Комментарии : 109   
@yaaragiladi1199
@yaaragiladi1199 2 года назад
I am anesthesiologist and icu fellow. Your lectures are the best! Thank you so much for these wonderful lessons.
@ICUAdvantage
@ICUAdvantage 2 года назад
Very cool! Truly happy to be able to help!
@carsonwong2710
@carsonwong2710 3 года назад
I would definitely pay to attend your lectures. Thank you so much
@ICUAdvantage
@ICUAdvantage 3 года назад
Haha thank you! Maybe one day 😉
@sasagalal
@sasagalal 8 месяцев назад
I am a pediatric intensivist, your CRRT videos helped me alot, thank you so much 😊
@Zeeman999
@Zeeman999 3 месяца назад
Your CRRT videos are magic
@travisf150r
@travisf150r Год назад
Im a biomed that maintains and repairs these machines. Your videos are very helpful to understand how these devices are being used on the floor. Will be sharing with younger techs going forward as part of their training.
@viosaa3899
@viosaa3899 3 года назад
You are a wonderful person, thank you for your time!
@ICUAdvantage
@ICUAdvantage 3 года назад
Thank you so much. Too kind!
@melodies92
@melodies92 Год назад
this channel and all of your videos are so amazing and helpful. THANK YOU!!
@shiminwong2327
@shiminwong2327 2 года назад
I have been watching since the first lesson of CRRT ! It was clear and easy to understand !
@ICUAdvantage
@ICUAdvantage 2 года назад
Yay so happy to hear this!
@fencer5411
@fencer5411 3 года назад
Thanks for all the work you put into these videos!
@ICUAdvantage
@ICUAdvantage 3 года назад
You are very welcome. I'm glad to hear that you and others are enjoying them!
@kathleenclairecaneja9157
@kathleenclairecaneja9157 2 года назад
so good!!! loving most of your lectures ive seen
@ICUAdvantage
@ICUAdvantage 2 года назад
So awesome Kathleen! Really glad you are liking them! :)
@vedranstojanovic9848
@vedranstojanovic9848 12 дней назад
Very useful. Thank u!
@puterinuriman7943
@puterinuriman7943 3 года назад
The entire CRRT explained series is super informative and well-explained. Thank you so much for your wonderful videos! Greetings from Malaysia 🇲🇾
@ICUAdvantage
@ICUAdvantage 3 года назад
How cool! Hello in Malaysia Puteri! Glad you liked the series!
@icudangmateo9776
@icudangmateo9776 2 года назад
You are so, soooo helpful to a lot of people like myself. Thank you so much for sharing these CRRT lectures. God bless you!
@ICUAdvantage
@ICUAdvantage 2 года назад
Very happy to hear this. Glad to be able to help!
@watsupnook1
@watsupnook1 3 года назад
Thank you to made such a wonderful videos. I feeling like fall in love today since i watched some of them.
@ICUAdvantage
@ICUAdvantage 3 года назад
So glad to hear that you like it! :) So nice of you
@xolanisikhakhane8654
@xolanisikhakhane8654 3 года назад
Great lecture, learnt something new today. Thanks a lot!!!
@ICUAdvantage
@ICUAdvantage 3 года назад
Awesome to hear this! You are very welcome.
@mirandaalexis
@mirandaalexis 3 года назад
always a good refresher
@ICUAdvantage
@ICUAdvantage 3 года назад
Awesome! 😊
@Laringoskop
@Laringoskop 3 года назад
Thank you for your lectures,it makes me understand rrt more deeply.
@ICUAdvantage
@ICUAdvantage 3 года назад
You are welcome! Glad you are enjoying the series.
@R3lly88
@R3lly88 Год назад
just took the class yesterday and this definitely helped to make things clearer in terms of rationale. Ty.
@ICUAdvantage
@ICUAdvantage Год назад
Awesome. Glad it was able to help cement the stuff you learned in class!
@salimohammed7012
@salimohammed7012 3 года назад
Very easy to understand
@ICUAdvantage
@ICUAdvantage 3 года назад
Thanks for liking
@Blessings237
@Blessings237 Год назад
It’s an interesting lesson!! I enjoyed watching it.😊👍
@forever4uuu
@forever4uuu 3 года назад
Sir love your lectures and Thanks for being so passionated about your field
@ICUAdvantage
@ICUAdvantage 3 года назад
I enjoy teaching and sharing this info. Also great to hear its well received! Thank you!
@jmw77
@jmw77 3 года назад
WOW. Amazing work, I have to say I learned so much about this topic which is a common frustrating issue I encounter when Im administrating CRRT. My hospital has not set a proper protocol for anticoagulation for CRRT, and your explanation of the use of Citrate/Calcium will help me advocate for my patients. Thank You!
@ICUAdvantage
@ICUAdvantage 3 года назад
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!
@henriquelopes9596
@henriquelopes9596 3 года назад
Thanks. Very helpful.
@ICUAdvantage
@ICUAdvantage 3 года назад
Awesome! So glad to hear this!
@vimohankumar9151
@vimohankumar9151 2 года назад
Thanks for such a lucid lecture
@ICUAdvantage
@ICUAdvantage 2 года назад
Glad you liked it!
@or_-
@or_- 10 месяцев назад
thank you, very helpfull
@ICUAdvantage
@ICUAdvantage 10 месяцев назад
Happy to hear!
@dorothyotogbolu6485
@dorothyotogbolu6485 Месяц назад
awesome videos
@Pinoykid53
@Pinoykid53 3 года назад
at 6:28, I think you meant 1 MG of protamine to every 100 units of heparin, instead of 1 gram. Amazing video, and easy to follow. Much appreciated!
@ICUAdvantage
@ICUAdvantage 3 года назад
Yup! Unfortunately I can't go back and fix it. I tried to include the correct info in the lesson description.
@sohazouwail2974
@sohazouwail2974 3 года назад
Hi, I am a chemical Pathologist and I enjoyed the lecture explaining clearly the role of citrate and impact on ionised calcium. Thank you
@ICUAdvantage
@ICUAdvantage 3 года назад
Awesome! glad you liked it!
@sayannathcmc286
@sayannathcmc286 Год назад
Thanks for the simplification of such a complex topic. One small observation: the dose of protamine is 1mg for every 100 units of heparin. In this video you have mentioned 1g for every 100 units of heparin.
@astrid5870
@astrid5870 3 года назад
These videos are sooo helpful. Thank you for this series! Could you add a more PRACTICAL hands-on video on how exactly to set up the Prismaflex, as well as how connect and disconnect it from the patient? That would be fab😘
@ICUAdvantage
@ICUAdvantage 3 года назад
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.
@leenunn3515
@leenunn3515 2 года назад
Thanks!
@ICUAdvantage
@ICUAdvantage 2 года назад
Thank you so much Lee!!
@rma3899
@rma3899 3 года назад
Like always, you are the best
@ICUAdvantage
@ICUAdvantage 3 года назад
Thank you!! 😊
@rma3899
@rma3899 3 года назад
@@ICUAdvantageXOXO
@FastLikePuma
@FastLikePuma 2 года назад
Your awesome!!!
@ICUAdvantage
@ICUAdvantage 2 года назад
You're too kind!
@judithtankam4851
@judithtankam4851 2 года назад
Thank you
@tomriley5790
@tomriley5790 Год назад
Not come accross people using DTIs for renal filtration but interesting to see people do. We nearly always use regional citrate failing that systemic heparin, personally I find citrate works really well for the majority of patients.
@ronniemarshall7482
@ronniemarshall7482 3 года назад
I love this video
@ICUAdvantage
@ICUAdvantage 3 года назад
Yay!! So glad to hear this!
@muneermangalath
@muneermangalath 3 года назад
Thank you sir
@ICUAdvantage
@ICUAdvantage 3 года назад
Welcome
@SamanthaWhite-if5bz
@SamanthaWhite-if5bz 10 дней назад
I just went back bedside after being an ARNP for 7 years. I am trying to revisit all the ICU topics. Thank you for all your help and videos. They explain things so easily. I did wonder since this video is 3 years old, is calcium citrate still being used? it seems like such a great option, but being back only 6 months, I don't see it in many order sets anymore. Just wondering if research changed or its just the doctors at my hospital. Thank you so much!
@user-qe8mg9en3c
@user-qe8mg9en3c 3 года назад
شكرًا جزيلا 👍♥️
@ICUAdvantage
@ICUAdvantage 3 года назад
Not sure what you said, but with the thumbs up and heart I'll assume it was good 😊 So thank you lol
@andreng9904
@andreng9904 3 года назад
Awesome lecture. Currently on my Renal Med rotation and this goes a long way toward helping me understand CRRT!
@ICUAdvantage
@ICUAdvantage 3 года назад
So cool! Glad this video was able to help!
@arshadhussain8797
@arshadhussain8797 Год назад
Hi! Pls make a series on standard protocol treatment that is followed in ICU for treating common ICU cases.... Thanks
@dysondt2239
@dysondt2239 2 года назад
Verithanam
@mohammada.samaan8195
@mohammada.samaan8195 3 года назад
Thank you very much for this lecture, but i think still we need to know more for the regional Citrate A.G in terms of the ratios Ci-Ca, mixing ratio for Ci-Ca , how can we control & manage the therapy Ci-Ca ( parameters setting )
@almuntheralaalem362
@almuntheralaalem362 2 года назад
plz we need explain about fluid calculation and adjustment thank you
@nikhilchakravarthy5593
@nikhilchakravarthy5593 3 года назад
You are awesome bro;-)
@ICUAdvantage
@ICUAdvantage 3 года назад
Too kind! I really appreciate you and glad you liked it!
@WaleedElShatshat
@WaleedElShatshat 2 года назад
Man u r awesome your videos are helpful specially here in 3rd world countries
@jadecopperstone4621
@jadecopperstone4621 3 года назад
Great videos. Do you mind explaining why some nephrologist will transition from citrate to non-citrate? Is it once they are likely going to be coming off of crrt soon?
@ICUAdvantage
@ICUAdvantage 3 года назад
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.
@nier7889
@nier7889 3 года назад
Thx for your great presentation! Why i didn't find this channel earlier?! But it would be good if you correct 1 mistake on 6:33 min please: every 100U Heparin = 1 MG protamine (not G). All Drs know it's just mistake, but some residents may remember that ) Thank you again, Dr. Watson )
@ICUAdvantage
@ICUAdvantage 3 года назад
Ugh, I swear I also manage to fit at least one mistake in to every video! 🤦🏻‍♂️ Yup MG not GRAM! Unfortunately RU-vid 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!
@gtrmageddon
@gtrmageddon 3 года назад
I will most likely begin using Prisma. Could you recommend reading material ? I would like to get a head start.
@ICUAdvantage
@ICUAdvantage 3 года назад
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.
@ragdakarim1919
@ragdakarim1919 3 года назад
Thank you for a great seminar. I would like to know what happens with the calcium citrate that will reneter the patients blood? Since the kidneys cant get rid of the calcium citrate how will it be excreted?
@lum859
@lum859 3 года назад
Citrate is metabolized by the liver
@ICUAdvantage
@ICUAdvantage 3 года назад
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.
@heatherevery3796
@heatherevery3796 2 года назад
What are the downfalls of using Calcium/Citrate for anti coagulation? I rarely see this used and the times I have, you’re infusing a large volume of just those two medications which makes it difficult to remove via CRRT. Also, could this be an option for anticoagulation on ECMO? Thank you for the informative videos!
@Nursevive
@Nursevive 2 года назад
Hi. Do we need to follow the Baxter recommendation that filter should change every 72 hrs? since we are using citrate/ca anticiloagulant?
@ahmedtwahir8334
@ahmedtwahir8334 3 года назад
What is the recommended ratio of HD to HF when you are doing CVVHDF
@ICUAdvantage
@ICUAdvantage 3 года назад
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.
@etlay5684
@etlay5684 2 года назад
Hi Eddie, is it safe to prime the circuit with 5000u Heparin for patients who have risk of bleeding? Thanks
@ICUAdvantage
@ICUAdvantage 2 года назад
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.
@karenmartinez9596
@karenmartinez9596 Год назад
How can I tell the difference between the CRRT Heparin syringe (systemic anticoag), vs the Heparin given pre-filter (regional anticoag)?? During my orientation we used a Heparin syringe only attached to a slot on the Prismaflex but how can I tell if the CRRT Heparin is going pre-filter or post filter. And we didnt use any Protamine.
@ICUAdvantage
@ICUAdvantage Год назад
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.
@mohsinrasheed7811
@mohsinrasheed7811 Год назад
6:30 1mg of protamine (not gram). Otherwise excellent work :-)
@ICUAdvantage
@ICUAdvantage Год назад
Yup! I've got that correction I had put in the video description, but yeah not sure what happened there!
@icuicu1187
@icuicu1187 2 года назад
this CRRT series is amazing. I have a query. When we start CRRT for fluid overload and AKI, patient becomes anuric. This is probably due to fall in concentration gradient across renal tubules ( this is what i have learnt. Not read it anywhere). We had started CRRT for fulminant hepatic failure for ammonia and high lactaes without signs of fluid overload, his urine output remained normal. Is there any explanation for this difference? thank you for this video
@ICUAdvantage
@ICUAdvantage 2 года назад
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.
@icuicu1187
@icuicu1187 2 года назад
@@ICUAdvantage thanks for replying.
@aman1644
@aman1644 3 года назад
Its 1mg of protamine sulphte for 100u of heparin if given within 30 mins. Isnt it?
@ICUAdvantage
@ICUAdvantage 3 года назад
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.
@wemurray4
@wemurray4 3 года назад
@@ICUAdvantage it should read mg not grams
@sirishgauni
@sirishgauni 3 года назад
correction: 1 mg of protamine for 100 units of heparin, not 1gm
@ICUAdvantage
@ICUAdvantage 3 года назад
Yup. Slip of the tongue and corrected in video description.
@viviliberton6196
@viviliberton6196 3 года назад
Doesn't 1 mg of protamine reverse 100 IU of heparine? I found online that 1 ml (10 mg protamine sulfaat) neutralises about 1400 I.E. heparine. 1 gram seems a bit much ;)
@ICUAdvantage
@ICUAdvantage 3 года назад
Haha yeah, its a little excessive. Slip of the tongue which I had corrected in the video description when it was first noticed.
@osaheniosas4731
@osaheniosas4731 3 года назад
Please on the average how much heparin have you administered to a 70kg man over 24 hours? Can you do CRRT continously for 5 days non stop?
@ICUAdvantage
@ICUAdvantage 3 года назад
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.
@osaheniosas4731
@osaheniosas4731 3 года назад
@@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?
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