Hi, I am a clinical nurse educator in critical care in the UK. I thought all 3 videos on CRRT were great, I have worked with various CRRT machines but never felt confident explaining it to others and this will really help me during clinical teaching sessions. Thanks
Couple extra facts: Adsorption removes pro-inflammatory mediators and anti inflammatory mediators, as patients in states like sepsis the scale is overwhelmingly in favor of pro inflammatory mediators, crrt can help balance the scale to remove those pesky molecules. Also when thinking of molecule size a professor I had helped me think of it like this : Glucose has a molecular weight of 180 (like a man in pounds) albumin can have a mw of 65000 (think an 18 wheeler) , for size comparisons when thinking what is filtered and what is not by a normal kidney or crrt circuit
Not sure about North America but in the UK, we've got special sets for our Prismaflex filters that have high adsorption membranes - the oXiris set. It's exactly for this, removal of cytokines and endotoxins
I recently joined ICU nursing and CCRT was a part of my orientation,. I had four live sessions, which got me through, but left many unanswered questions. Your series wrapped my gaps up and I started to get it much better. So thank you for sharing your knowledge and experience!!!
Awesome, welcome to the world of critical care and CRRT! Glad to hear these videos were able to bring together the info you needed to better understand whats going on. 😊
Can you please make a video about Swan set up and explanation please? When patients come out of OR post-op, the ways anesthesiologist set up the tubs/lines of swan are all different, it's confusing sometimes. Thank you. Really like your videos!
Thank you again for all your videos! Just over a year of ICU experience here and I’m still overwhelmed. Your videos really break it down easily for me. Thank you and keep up the great work you’re doing here!
Glad they are helpful for you Karen. It can be overwhelming sometimes for quite some time. Just stick with it, learn something new each day, focus on getting a system so you don't have to think about certain things, but don't be afraid to deviate from the plan to deal with something that comes up. You'll get there!
Thank you so much Ed. Im always watching your videos. I've been an ICU nurse for more than 4 years and in my previous hospital, we've been very dependent to Nephro nurses for CRRT. When I moved to UK recently, I was expected to do CRRT on my own and your videos are very timely as I try to refresh my knowledge on this. More power Ed. Can't wait for your upcoming videos.
Thanks Matt! I appreciate you watching the videos and so glad to hear that they are liked. One hospital I moonlighted at for a little bit would do a similar thing. They would call in a dialysis nurse to do filter changes and put up a new circuit. Even at night they would come in for that. I was astonished as everywhere else I had worked we would just do it all. Interesting how things are so different in some places.
Hey, I am a recent medical grad and current intern and I found this video to be so helpful in helping me understand renal replacement therapy. Really strong work!!
I appreciate this so much, just started orientation on CTICU and I had a pt on crrt and impella. It was a lot to juggle but your videos have helped me understand a lot that some haven't explained so well. Thank you for your dedication, can't wait to see what else you have in store.
ICU nurse in C-19 unit had to run CRRT two days in a row, scared but not showing it. After watching these I do feel a bit more relaxed. I am sending the link for this youtube cghannek to the newer nurses!!
YES! Awesome! I remember having that same aha moment about the post-dilution when at the time I couldn't wrap my head around how giving fluids to the blood as it is returning to the patient would help in any way with increasing clearance. Glad to have been able to help!
Awesome to hear! Thats the whole goal! I always tell everyone you can train a monkey to run the machine, but to really understand whats happening, thats the key. Glad this video helped!
Thank you for doing this videos❤️, so glad that you make these videos, it is a life saver. I’ve been working in icu and I’ve worked with these Prismaflex machines. I actually think it is a cute user friendly machine but to understand the concepts and troubleshooting is hard and intimidating at times, sometimes these machines have minds of their own. I absolutely love your simple explanation, it’s too the point but you have covered everything , I like how you used drawings to illustrate your point, that really helps me understand the concepts better and using analogies too. I’ve read a lot of manuals but the info is complicated, you make it easy to understand. Please continue making more videos of common equipment used in icu and troubleshooting tips🥰. And just out of curiosity, can I ask what is your background, are you a nurse or doctor?. I am just wondering as I really like your teaching style and hope to learn good skills like this when teaching newbies.
Excellent video. When you talked about convection I rewinded to ultrafiltration as I wasn't sure the difference. I see that they go hand in hand as convection is the movement of solutes dissolved within the solute across the membrane. Ultrafiltration is the movement of the fluid across the membrane due to osmotic or hydrostatic pressure and convection will therefore happen with that movement of fluid. Does that sound correct?
Yes you are 100% correct!! Convection requires the movement of water. The more movement we have the more "drag" we get of the solutes across the membrane. We drive this fluid movement through the pressure gradient. That said, you can use just enough ultrafiltration to remove fluid without significant solute drag, but typically it is the combination of all of this together, especially in CVVHDF that we use for maximum benefit for the patient.
Is it ok to interchanged dialysate fluids to a replacement fluids? I have noticed that some nurses uses dialysate as a replacement solution if we ran out! I could not get an answer from Baxter. Does anyone knows? I don’t think it’s fda approve to do this.
Hi new to your channel. I’m a newer icu nurse, transitioned from Adult Emergency to SICU Noticed you don’t have any videos on ICP/CPP and EVD’s We have a lot of Neuro pts and that’s something I’d like to get more comfortable with. Any chance you can make a video on this topic?
Hi! That's a great wrap up from critical care point of view. I appreciate it a lot. Can we have a plasmapheresis next time if you don't mind!! Thanks so much Sir Ed.
So, I'm being told CRRT CVVHD causes Calcium Chelation, so we check the Ionized Calcium Q6-Q12H to replace, but the population is unique and it could be due to blood products. Multiple depts have reiterated that CRRT = low calcium. Is this correct or is it due to blood products, or bc it's technically like a transfusion process with blood under pressure? Thanks!
Are you running citrate anticoagulation? Citrate chelates calcium and is used as a local anticoagulant for the CRRT circuit. I do have another video talking about CRRT anticoagulation. It is the same citrate in blood products that does the same thing. I have not heard of, nor seen, CRRT without citrate causing issues with calcium levels.
Thank you that was awesome. So essentially the replacement fluid is the fluid we give the patient that is then used for convection or do we use the patients own fluid for convection and then replace? Sorry silly question but really want to understand. Thanks again.
Glad to hear you liked it! Great question. You've got it. By giving them fluid, this allows us to pull a larger volume, thus faster flow, back out, increasing that convection. If we didn't give them this fluid, we wouldn't be able to pull as much fluid from the patient.