Seminars in dialysis
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Volume management is an integral component of the care of critically ill patients to maintain hemodynamic stability and optimize organ function. The dynamic nature of critical illness often necessitates volume resuscitation and contributes to fluid overload particularly in the presence of altered renal function. Diuretics are commonly used as an initial therapy to increase urine output; however they have limited effectiveness due to underlying acute kidney injury and other factors contributing to diuretic resistance. ⋯ Complications related to excessive ultrafiltration can occur and have serious consequences. A careful monitoring of fluid balance is therefore essential for all patients. This review provides an overview of the appropriate assessment and management of volume status in critically ill patients and its management with CRRT to optimize organ function and prevent complications of fluid overload.
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A working vascular access is essential for performing continuous renal replacement therapy (CRRT) efficiently and without interruption. Dual-lumen temporary hemodialysis catheters are the catheters of choice, although tunneled catheters can also be utilized if therapy is expected to be prolonged. ⋯ Catheter malfunction and catheter-related infections can be reduced by adhering to preventive guidelines such as ultrasound guidance for placement, strict hand hygiene, gauze dressings, and sterile techniques during catheter handling. Antibiotic or antiseptic-coated catheters and lock solutions may be beneficial in certain patients, but these are not widely used due to the concern for resistant organisms and allergic reactions.
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Seminars in dialysis · Jan 2009
ReviewHemoglobin control, ESA resistance, and regular low-dose IV iron therapy: a review of the evidence.
Anemia management in hemodialysis patients has progressed following the introduction of erythropoiesis-stimulating agents (ESAs) and intravenous (IV) iron. However, maintaining a stable hemoglobin (Hb) level can be challenging. ⋯ Fluctuating Hb levels is associated with increased complications. This article reviews factors that affect Hb control, with a focus on management practices (e.g., regular low-dose administration of IV iron) that can help improve anemia management.
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Seminars in dialysis · Sep 2008
Practice GuidelineLocking solutions for hemodialysis catheters; heparin and citrate--a position paper by ASDIN.
There is wide variation in the use of solutions to "lock" or fill tunneled central venous catheters for dialysis. Some centers use undiluted heparin concentrations ranging from 1000 to 10,000 U/ml and other centers place from 1000 to 10,000 U per lumen. Based on available evidence, it appears that heparin 1000 U/ml, or 4% sodium citrate are suitable choices for lock solution to maintain patency of tunneled central venous catheters for dialysis. ⋯ Higher concentrations of heparin lock should be reserved for patients who have evidence of catheter occlusion or thrombosis when heparin is used at 1000 U/ml. Similar choices for lock solution are sensible for acute hemodialysis catheters. When heparin is used for catheter lock, the injected volume should not exceed the internal volume of the catheter.
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Seminars in dialysis · Sep 2008
A modified supraclavicular approach for central venous catheterization by manipulation of ventilation in ventilated patients.
Because of overuse and multiple implantations of hemodialysis catheters through internal jugular or subclavian vein (SCV) in patients with chronic hemodialysis, these veins often become stenotic or occlude, therefore necessitating alternative access. We introduce a new technique in ventilated patients for placement of tunneled cuffed chronic hemodialysis catheter: modified supraclavicular approach by cease of ventilation. ⋯ The modified supraclavicular approach with lung deflation for tunneled cuffed chronic hemodialysis catheter in ventilated patients is at least as effective as traditional approach and can be easily performed by surgeons as well as experienced physicians. Based on the results, this simplified technique using lung deflation may be particularly useful to decrease procedural complications.