|Connects the Circuit
Confirms Blood Flow Rates
Set the flow rate as per orders. Set initial blood flow rate to 150 ml/min.
Adds Saline Flush
Connect the circuit to the catheter as follows:
If a heparin bolus has been ordered, administer the bolus directly into the access limb (red) just prior to connecting the circuit.
- Attach the heparin containing syringe to the access limb (red) of the dialysis catheter.
- Open the access limb clamp.
- Inject the heparin into the access limb.
- Reclamp the access limb.
- Connect the stopcock/saline infusion to the access (red) end of the CRRT circuit.
- Connect to the access limb (red) of the dialysis catheter to the stopcock (the limb and dialysis circuit should be in straight alignment with saline at 45 degrees..
- Connect the return (blue) end of the CRRT circuit to the return limb (blue) of the dialysis catheter.
Opens all Clamps:
- Open the access and return clamps.
- Close the stopcock to the saline infusion.
- Open the roller clamp of the saline infusion.
- Ensure that all clamps in the CRRT circuit are open.
- Initiate treatment
- Monitor circuit closely for leakage or air bubbles
- Increase blood flow rate quickly to ordered rates.
If treatment is started with lower blood flow rates, the access alarm will be too low (i.e., less negative). As blood flow increases, the access pressure becomes more negative (more “suck” is required to pull the larger blood flow volume). If the access pressure is less negative than minus 10, the CRRT machine will interpret this as a disconnected access limb and generate an alarm. To avoid access disconnection alarms, escalate the blood flow rate quickly during initiation of treatment.
If pump pressures permit, increase the blood flow rate as quickly as possible until it is 250 mL/min (or as high as pressures allow). Higher blood flow rates can reduce filter clotting by shortening the duration of time that blood remains in the filter. Blood flow rates must be increased as quickly as possible for maximum clotting reduction benefit.
The heparin bolus has a total volume that is smaller than the volume of the catheter limb, therefore, the heparin bolus will remain in the limb until the treatment is started.
Upon initiation, the first blood that will drawn into the catheter will contain heparin. Thus, the first blood to reach the filter will be anticoagulated.
Once the circuit is connected, all clamps should remain open. Any time that a high priority alarm is activated, the blood pump automatically stops and the blood flow circuit closes (safe mode).
If therapy is initiated with any clamps closed, the CRRT machine will immediately alarm and shut down. Repeated alarms during initiation may lead to treatment failure/shut down.