CVVH/CVVHDF Prescription
Addressograph
Date: from 12.00 ___/___/___ to 12.00 ___/___/___
Vascath lumen volume
Weight:
* refer to vascath bundle and drug chart
Allergies:
Red lumen
mls
Blue lumen
mls
* heparin for hep-lock must be prescribed on drug chart
Circle treatment option
CVVH
Vascath size and length:
CVVHDF
Initial Prime of Circuit
Nurse 1 (sign + print)
Nurse 2 (sign + print)
Heparin 5000units / 1 litre 0.9% sodium chloride
(not delivered to patient)
Dr’s Signature
Priming Fluid
(sign + print)
Prescribe blood product on All Wales
Transfusion Chart
Nurse 1
Nurse 2
(sign + print)
(sign + print)
0.9% Sodium Chloride
4.5% Human Albumin Solution
(if < 20kg)
*If patient < 10kg consider the need for packed red cells directly to patient
ANTICOAGULATION (HEPARIN)
Heparin - 125 Units / kg (0.125ml/kg of 1000U/ml heparin) made up to 50mls with 0.9% Sodium
Chloride so that 1ml /hr = 2.5 units/kg/hr.
Heparin ……………… Units in 0.9% sodium chloride 50 mls.
(= …………ml of 1,000 Units / ml)
(run according to the guidance overleaf)
Doctor’s signature (sign + print)
Time
Nurse 1 (sign + print)
Nurse 2
(sign + print)
Time
1)
3)
2)
4)
Nurse 1 (sign + print)
Nurse 2 (sign + print)
1
CVVH/CVVHDF Prescription
Addressograph
START UP ANTICOAGULATION (HEPARIN)
Baseline ACT: ………
* This should be performed within 4 hours of treatment from a non-heparinised line
ACT < 180 seconds – Bolus
Infusion
ACT > 180 seconds – Bolus
Infusion
10 Units/kg of Heparin
10 Units/kg/hour (run at 4mls/hour)
no bolus required
5 Units/kg/hour (run at 2 mls/hour)
Heparin bolus:………… units/kg
Doctor’s signature (sign + print)
* Heparin bolus to be given into red port pre-filter
Heparin infusion rate: ……….. units/kg/hour
Nurse 1 (sign + print)
Nurse 2 (sign + print)
ONGOING ANTICOAGULATION (HEPARIN)
Maintain ACT between 160 and 180 seconds - sample ACT from blue port (post-filter)
ACT < 160 seconds – increase heparin infusion by 2ml (5 units / kg) / hour
ACT > 180 seconds – decrease heparin infusion by 2ml (5 units / kg) / hour
ANTICOAGULATION IF HEPARIN CONTRAINDICATED:
EPOPROSTENOL
500 micrograms in 50ml 0.9% sodium chloride - Start at 3 nanograms/kg/minute and adjust as needed
(maximum 10 nanograms/kg/minute)
(0.06ml/kg/hr = 10 nanograms/kg/min.)
Doctor’s signature
(sign + print)
Epoprostenol infusion rate: ……………. nanograms/kg/min.
= ……………. mls/hour
Nurse 1
(sign + print)
Nurse 2
(sign + print)
2
CVVH/CVVHDF Prescription
Addressograph
PROGRAMME
Blood Flow Rate -
* Guidance can be found in CRRT prescription guide
Start at ……….. ml/minute
(half of minimum BFR)
Substitution fluid rate
Increasing as tolerated to ……….. ml/minute
* This should be as quick as possible to prevent filter clotting
mls/hr
*Usually ⅓ pre dilution, ⅔ post dilution
Dr’s signature
Nurse 1
Nurse 2
(sign + print)
(sign + print)
(sign + print)
Dr’s signature
Nurse 1
Nurse 2
(sign + print)
(sign + print)
(sign + print)
Total Rate (refer to guidance)
Pre Blood Pump (pre-dilution)
Replacement (post-dilution)
Dialysate flow rate
PROGRAMME CHANGE
Substitution fluid rate
mls/hr
*Usually ⅓ pre dilution, ⅔ post dilution
Total Rate (refer to guidance)
Pre Blood Pump (pre-dilution)
Replacement (post-dilution)
Dialysate flow rate
PATIENT FLUID REMOVAL RATE
Time
Fluid Loss Rate or
Even Balance
Dr’s signature
Nurse 1
Nurse 2
(sign + print)
(sign + print)
(sign + print)
1)
2)
3)
4)
5)
6)
3
CVVH/CVVHDF Prescription
Addressograph
SUBSTITUTION FLUID
The prescribed substitution fluid is to be used for the pre-blood pump, replacement and dialysate lines.
If CVVHDF is not used attach a 1L bag of 0.9% sodium chloride to the dialysate line (green line) and clamp line .
Additives to Hemosol B0 5 litre (important: 20mmol potassium in 5 litres is equivalent to 4mmol/litre (physiologically normal). If prescribed total potassium > 20mmol/L discuss with consultant)
Potassium Acid
Potassium Chloride
Phosphate
1ml contains 2mmol of potassium
*substitution fluid must changed every 24hrs
Start
time
1ml contains 1mmol phosphate and
Time
Dr’s signature
1mmol potassium
Given/ Set
up by
Checked
by
Start
time
Given/ Set
Checked
up by
by
(maximum 10ml per 5L bag)
1)
mmol in 5 L
mmol in 5 L
2)
mmol in 5 L
mmol in 5 L
3)
mmol in 5 L
mmol in 5 L
4)
mmol in 5 L
mmol in 5 L
5)
mmol in 5 L
mmol in 5 L
6)
mmol in 5 L
mmol in 5 L
7)
mmol in 5 L
mmol in 5 L
8)
mmol in 5 L
mmol in 5 L
9)
mmol in 5 L
mmol in 5 L
10)
mmol in 5 L
mmol in 5 L
4
CVVH/CVVHDF Prescription
STANDARD FLOW RATES
Weight
Total
Dialysate
Min. blood
Max. blood
substitution
flow rate
flow rate
flow rate (BFR)
rate
(mls/hr)
(BFR)
(mls/min)
(mls/hr)
(mls/min)
2.5
75
50
20
30
5
150
100
30
45
10
300
200
60
90
15
450
300
90
120
20
600
400
120
150
25
750
500
150
180
30
900
600
180
240
35
1050
700
180
240
40
1200
800
180
240
45
1350
900
180
240
50
1500
1000
180
240
The machine will allow blood flow speeds up to maximum of 400mls/min, but this is often
not achievable or necessary
5
CVVH/CVVHDF Daily Prescription
4