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POST-DILUTION FLOW RATES:

Improved clearance is achieved (15%). Use in severely septic/acidotic patients; significantly elevated biochemical values; abnormal white cell count.

Dialysate may be prescribed at the discretion of the Consultant Intensivist in the following:

• Urea ≥ 30.

• Severe poisoning.

Commencing and discontinuing dialysate:

• Replacement therapy (pre-blood pump and post replacement) continues at 30ml/kg/hr.

• Initiate dialysate at 2000 ml/hr.

• Dialysate exchange rates may be increased beyond 2000 ml/hr at the discretion of the Consultant Intensivist.

• Consider discontinuing dialysate when Urea ≤ 20 after discussion with Medical Staff.

|Bodyweight kg |

| | |

|HEPARIN MANAGEMENT: |POTASSIUM MANAGEMENT |

| | |

|Contra-indications: |Aim to maintain potassium level 4.0 mmol/litre |

| | |

|Diagnosis of any significant bleeding disorder. | |

|Active bleeding. | |

|When a high risk of bleeding is anticipated. | |

|INR > 2.0 | |

|Stop heparin infusion when platelet count < 60. | |

|Stop heparin infusion when APTT ratio > 2.5. | |

|Stop heparin infusion when PTT > 40. | |

| | |

| | |

|Heparin infusion: | |

| | |

|Heparin must be prescribed on the drug kardex. | |

|Infusion: 20,000 international units in 20ml . | |

|Infusion rate: 500 international units per hour. | |

|APPT ratio is maintained within range 1 – 1.5. | |

| | |

| | |

|Additional information: | |

| | |

|APTT ratio does not always reflect the anticoagulation effect of unfractionated heparin and there is no | |

|correlation between increasing APPT and filter life. | |

|Heparin is the most cost effective anticoagulant and is fully reversible with protamine. | |

| | |

| | |

|Heparin and priming procedure: | |

| | |

|1ST bag: 1000 iu heparin added to 1 litre saline 0.9% | |

|Followed by a litre bag 0.9% saline without heparin added. | |

| | |

| | |

|Heparin lock in vascath ports: | |

| | |

|Use vial containing 1000 international units heparin per ml. | |

|Lock each port with the volume indicated on the catheter. | |

|Remove heparin lock prior to recommencing haemofiltration treatment. | |

| | | | |

| |K+ LEVEL |SUBSTITUTION FLUID |EXTRA MONITORING REQUIREMENTS |

| | | | |

| | | |Monitor K+ level every 30 minutes. Does not |

| |≥ 8.0 mmol/litre |Hemosol BO |contain glucose or phosphate therefore plasma |

| | | |levels need to be monitored closely. |

| | | | |

| | | |Monitor K+ level every 30 minutes. Does not |

| |6.6 - 7.9 mmol/litre |Prismasol 2 |contain phosphate therefore the plasma level needs |

| | | |to be monitored closely. |

| | | | |

| | | | |

| |≤ 6.5 mmol/litre |Prismasol 4 |Does not contain phosphate therefore the plasma |

| | | |level needs to be monitored closely. |

| | | | |

| | |

Dialysate may be prescribed at the discretion of the Consultant Intensivist in the following:

• Urea ≥ 30.

• Severe poisoning.

Commencing and discontinuing dialysate:

• Replacement therapy (pre-blood pump and post replacement) continues at 30ml/kg/hr.

• Initiate dialysate at 2000 ml/hr.

• Dialysate exchange rates may be increased beyond 2000 ml/hr at the discretion of the Consultant Intensivist.

• Consider discontinuing dialysate when Urea ≤ 20 after discussion with Medical Staff.

|Bodyweight kg |

| | |

|HEPARIN MANAGEMENT: |POTASSIUM MANAGEMENT |

| | |

|Contra-indications: |Aim to maintain potassium level 4.0 mmol/litre |

| | |

|Diagnosis of any significant bleeding disorder. | |

|Active bleeding. | |

|When a high risk of bleeding is anticipated. | |

|INR > 2.0 | |

|Stop heparin infusion when platelet count < 60. | |

|Stop heparin infusion when APTT ratio > 2.5. | |

|Stop heparin infusion when PTT > 40. | |

| | |

| | |

|Heparin infusion: | |

| | |

|Heparin must be prescribed on the drug kardex. | |

|Infusion: 20,000 international units in 20ml . | |

|Infusion rate: 500 international units per hour. | |

|APPT ratio is maintained within range 1 – 1.5. | |

| | |

| | |

|Additional information: | |

| | |

|APTT ratio does not always reflect the anticoagulation effect of unfractionated heparin and there is no | |

|correlation between increasing APPT and filter life. | |

|Heparin is the most cost effective anticoagulant and is fully reversible with protamine. | |

| | |

| | |

|Heparin and priming procedure: | |

| | |

|1ST bag: 1000 international units heparin added to 1 litre saline 0.9% | |

|Followed by a litre bag 0.9% saline without heparin added. | |

| | |

| | |

|Heparin lock in vascath ports: | |

| | |

|Use vial containing 1000 international units heparin per ml. | |

|Lock each port with the volume indicated on the catheter. | |

|Remove heparin lock prior to recommencing haemofiltration treatment. | |

| | | | |

| |K+ LEVEL |SUBSTITUTION FLUID |EXTRA MONITORING REQUIREMENTS |

| | | | |

| | | |Monitor K+ level every 30 minutes. Does not |

| |≥ 8.0 mmol/litre |Hemosol BO |contain glucose or phosphate therefore plasma |

| | | |levels need to be monitored closely. |

| | | | |

| | | |Monitor K+ level every 30 minutes. Does not |

| |6.6 - 7.9 mmol/litre |Prismasol 2 |contain phosphate therefore the plasma level needs |

| | | |to be monitored closely. |

| | | | |

| | | | |

| |≤ 6.5 mmol/litre |Prismasol 4 |Does not contain phosphate therefore the plasma |

| | | |level needs to be monitored closely. |

| | | | |

| | |

-----------------------

PREFERRED TREATMENT CHOICE

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Refer to potassium management on opposite page

Hemosol BO and Prismasol 2 are for s梈棡棢棣椂椃楊榅榆榇榧榨槧橆櫐櫒櫔櫾欀歞òéé���Ü케Ï였Æ뤀¹뤀hort term duration only.

Convert to the appropriate substitution fluid as the potassium level reduces. Adhere to the parameters above.

PRE-DILUTION : FOR USE ONCE ACIDOSIS/BIOCHEMICAL VALUES ARE NORMALISED

Refer to potassium management on opposite page

Hemosol BO and Prismasol 2 are for short term duration only.

Convert to the appropriate substitution fluid as the potassium level reduces. Adhere to the parameters above.

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