Principles of CRRT Therapy - CRRT Explained!
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- Опубликовано: 19 июн 2024
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For this third lesson, we talk about the basic principles that guide CRRT therapy. These principles are the foundation for how our therapy works and enables us to mimic the job of the nephron. The 4 principles are, diffusion, ultrafiltration, convection, and adsorption. I go through, thoroughly explaining what each principle is and how it impacts the therapy we provide to our patients. Understanding this foundational information is essential in understanding the next lesson on the modes of CRRT therapy.
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0:00 Intro
1:51 Diffusion
7:17 Ultrafiltration
9:21 Convection
13:47 Adsorption
15:03 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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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
Hey sorry for the super late response but that’s so great to hear. Glad to know the videos have been helpful in finding your way to explain things!
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
Great points Alex! And yes, adsorption is great for helping with septic patients. Awesome perspective on the molecular weight too. Thank you!
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
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.
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.
Congrats on the new position in the CTICU. I agree, those Impella/CRRT patients are quite sick and quite busy. A lot to take in!
Always well explained. I'm learning a lot everytime I watch a new lesson. Thank you so much Eddie.
So awesome to hear this Mayah! Thanks for taking the time to leave a comment!
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. 😊
Viewed this video for a refresher for tomorrow's wet lab. Many aha moments while watching even after doing CRRT for a few years! Thank you!
This is great Lynne! Truly happy to be able to help! We are always learning!
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 so much for the kind words as well as for the suggestion. I do actually have Swans on the todo list!
@@ICUAdvantage when will your Swan video be coming out?
@@caitlynnichols3632 I’m not sure just yet. Probably sooner than later but I don’t have them planned out beyond the series I am currently doing.
Waiting for Swan setup
Great lesson. I'm having my class tomorrow. Thank you so much for it.
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!!
So cool to hear this! Glad I could help!
Great lesson! New ICU nurse trying to wrap my head around this. Thank you!
Thank you Chris. It takes a few goes, but eventually it starts to make more sense. Glad you liked the lesson!
Thank you so much. Looked after my second patient on crrt today. Was bombarded with questions.😅
I am happy I have found your channel. I work as an RN inED, and I have learnt so much from these sessions, so thank you so much
Awesome to hear this! happy you have enjoyed them!
Thank you for another great video man! Always appreciated!
You are certainly welcome Tristian! Thanks for watching!
Thanks for this! Very timely I am currently taking my critical care post grad and writing my assessment on CRRT. More power to you sir!
Awesome, that is good timing! haha
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!!
So great to hear this Shayla! I’m happy to have been able to help some and thank you for sharing the videos around!
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.
Well explained.. Thanks
im a new icu nurse.
Thank you for explaining this one.
Glad to be able to help and welcome to the wonderful world of ICU!
you really put so much effort brother rr...... Appreciate it!
Thank you! I certainly try my best to make them as best as I can.
Good bless you for info that you give us in these nice informative videos
Glad you liked it!
Awesome lesson. This me allowed to understand CRRT instead of just tasking via recording values and replacing bags. 👍
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!
That was such a great 3 lessons. Keep it up please :)
Glad to hear this! More coming!
great talk. thank you. very helpful
Happy to hear this!
Very helpful!!
Thank you so much for the information... New nurse trying to fill in the gaps from nursing school 😉
So glad to help! Glad that you liked the lesson. 😊
Informative...thanks for sharing this lesson
Glad it was helpful!
Thanks, well explained.
You're welcome and glad you liked it!
I am an ICU educator and I send all my new to ICU nurses (and experienced ICU nurses who want more info) to your channel for review.
How cool Ellie! Really glad to hear you find the videos of benefit for others and I greatly appreciate you helping to spread the word!
thank you
Thank you so much! New intern here this is awesome
Very cool! Glad you liked it.
Good ...thanks. waiting for the next video
Thank you. Coming next week! 😊
Eagerly waiting for next video in this series!!!
Out today. At least 2 more in the series coming!
ICU Advantage , checking out now.. thanks
the explanation around 11:40 was a huge "oooooh i get it moment." Thanks!
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!
Thank you so much for this! Could you do some teaching on how to return blood in CRRT?
I'm trying to remember if I cover that quickly in the last lesson in this series... maybe check it out and see if its there?
its very helpful thanks
Glad it helped
Super excellent presentation👌👍👍
Thank you so much Heba!
Thanks Sir Very Nice Information 🙏🙏🙏
You're welcome. Glad you liked it!
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?
Thank you !
You're welcome!
Excellent!
Thank you!
Sir how does adding replacement fluid post filter helps in convection?
Great 👍. I have one request please... Kindly give a video on Pain management in Cirrhosis of liver .
Thank you! I'll add those suggestions to the todo list.
Please explain dialysis disequilibrium syndrome
Thanks!
Thank you so much Onuhumma! ❤️
Great videos!
Thank you
Love your 📹🎥 videos
Thank you Carolann! Appreciate that!
Dziękujemy.
Bardzo dziękuję! 😊
hi, love your channel. Can you do a lesson on AKI in the ICU please? :D thank you!
Thank you! And yeah, let me add that to the todo list!
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.
Nice video!
Thanks!
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.
Great work ICU advantage, adding to you point, we can select CVVHDF so that we can change into any mode later if we want like CVVHD, CVVH, SCUF
Can do a video on crrt on a fresenius 2008 machine?
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.
Thank you so much
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.
Thank you Kath. I will add it to the todo list for the future.
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.
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If movement of particles is through semi permeable membrane, i think its called osmosis.
1:1
What happened to the subtitles? It writes some nonsense.
Thanks!
Thank you so much for that Brian!