ABSTRACTS from 16th International COnference on ... - CRRT Online

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A09 Vascular Access /Membrane and Circuit Luis Juncos MD 8:15-9:45 Wednesday, February 15 Educational Objectives: 1. To describe the fundamentals of hemodialysis catheters and their importance in maintaining adequate blood flow and circuit patency during CRRT. 2. To describe the basic characteristics of hemofiltration membranes and the different mechanisms by which they clear solutes <strong>from</strong> the blood. 3. To describe a typical CRRT circuit and discuss the practical issues related to the circuits during the different CRRT modalities. Content Description: To obtain maximum benefit of CRRT, one must achieve the therapeutic goals including the delivery of an appropriate dose. However, delivery of the prescribed dose of CRRT is frequently not accomplished for a variety of reasons. These include the frequent existence of a large amount of down time because of premature clotting or failure of the extracorporeal circuit, as well as the presence of suboptimal blood flows (which not only can decrease clearance, but also contributes to premature clotting). Moreover, frequent clotting/failure of the CRRT circuit not only leads to decreased dose delivery, but has many other important implications such as blood loss, irregular clearance that can cause suboptimal dosing of medications (e.g. antibiotics), and increase costs. Consequently, it is important to identify the cause of premature circuit failure and suboptimal dosing so that the cause can be specifically addressed. In this respect it is important to note that while insufficient anticoagulation is commonly assumed to be the most frequent cause of premature clotting, suboptimal blood flow mechanics within the circuit due to a poorly functioning/placed hemodialysis access is often (if not most often) the culprit. Thus, in order to better identify and address the cause of premature/frequent circuit clotting, it is essential that one understands the fundamentals of the CRRT circuit and membrane, and how they interact. This presentation will describe the fundamental concepts of the structure and function of dialysis catheters, CRRT circuits and membranes, as well as their interactions in determining the function of CRRT. Suggested Reading: 1. Vascular Access Work Group: Clinical practice guidelines for vascular access. Am J Kidney Dis 48(Suppl. 1):S248–S273, 2006. 2. Schwab SJ, Beathard G. The hemodialysis catheter conundrum: Hate living with them, but can’t live without. Kidney <strong>International</strong> Vol 56 (1999); 1-17. 3. Vijayan A. Vascular access for continuous renal replacement therapy. Semin Dial. 2009 Mar-Apr;22(2):133-6. Review. 4. Wentling AG. Hemodialysis catheters: materials, design and manufacturing. Contrib Nephrol. 2004;142:112- 27 5. Uchino S, Fealy N, Baldwin I, Morimatsu H, Bellomo R. Continuous is not continuous: the incidence and impact of circuit "down-time" on uraemic control during continuous veno-venous haemofiltration. Intensive Care Med. 2003 Apr;29(4):575-8. 6. Parienti JJ, Mégarbane B, Fischer MO, Lautrette A, Gazui N, Marin N, Hanouz JL, Ramakers M, Daubin C, Mira JP, Charbonneau P, du Cheyron D; Cathedia Study Group. Catheter dysfunction and dialysis performance according to vascular access among 736 critically ill adults requiring renal replacement therapy: a randomized controlled study. Crit Care Med. 2010 Apr;38(4):1118-25. 7. Parienti JJ, Thirion M, Mégarbane B, Souweine B, Ouchikhe A, Polito A, Forel JM, Marqué S, Misset B, 81
Airapetian N, Daurel C, Mira JP, Ramakers M, du Cheyron D, Le Coutour X, Daubin C, Charbonneau P; Members of the Cathedia Study Group. Femoral vs jugular venous catheterization and risk of nosocomial events in adults requiring acute renal replacement therapy: a randomized controlled trial. JAMA. 2008 May 28;299(20):2413-22. 8. Czepiak CA, O’Callaghan JM, Venus B. Evaluation of formulas for optimal positioning of central venous catheters. Chest 1995; 107:1662-64. 9. Aslamy Z, Dewald CL, Heffner JE. MRI of Central Venous Anatomy; Implications for Central Venous Catheter Insertion CHEST 1998; 114:820–826. 10. Vesely TM. Central Venous Catheter Tip Position: A Continuing Controversy. J Vasc Interv Radiol 2003; 14:527–534. 82
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CRRT 2012 SEVENTEENTH INTERNATIONAL
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FACULTY DISCLOSURES CRRT 2012 Facul
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CRRT 2012 ORGANIZING COMMITTEE USA
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CRRT 2012 FACULTY Patrick Honoré,
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ACKNOWLEDGEMENTS CRRT 2012 ACKNOWLE
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PLENARY SESSIONS CRRT 2012 PROGRAM/
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WORKSHOPS CRRT 2012 PROGRAM/INDEX T
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WORKSHOPS CRRT 2012 PROGRAM/INDEX W
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POSTER ABSTRACTS C
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POSTER ABSTRACTS C
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NURSING FORUM LUNCHEON Communicatio
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Nutritional Support in ICU Patients
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Educational Objectives: The Endothe
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Page 34 and 35: Nishimura R, Ornato JP, Page RL, Ri
Page 36 and 37: Do Vasoactive Drugs and Fluids Impr
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Page 40 and 41: Thinking Outside of the Box: A Nove
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Page 44 and 45: 4. Mori K, Lee HT, Rapoport D, Drex
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Page 48 and 49: Myocardial Stunning and Brain Edema
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Page 52 and 53: CRRT and ECMO: Techniques and Outco
Page 54 and 55: Management of Severe Heart Failure:
Page 56 and 57: Avoiding Anticoagulation for CRRT:
Page 58 and 59: Improving Outcomes from</st
Page 60 and 61: The Changing Face of AKI: Snapshots
Page 62 and 63: Alkaline Phosphatase Peter Pickkers
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Page 66 and 67: Surveillance and Early Recognition
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Page 70 and 71: A01 Assessing the Microcirculation
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Page 74 and 75: C03 Critical Care Pharmacology: Vas
Page 76 and 77: D04 Biomarkers 1: Principles and Ap
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Page 80 and 81: G07 Fluids and Solutions in the Cri
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Page 86 and 87: C11 Critical Care Management: Nutri
Page 88 and 89: D12 Biomarkers 2: Application in AK
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Page 92 and 93: G15 Fluids and Solutions in the Cri
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Page 118 and 119: H32 Withdrawing & Withholding Suppo
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