Aust Crit Care
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The use of citrate to anticoagulate the Continuous Renal Replacement Therapy (CRRT) circuit has not been widely adopted in Australia as an alternative to heparin due to treatment complexity and risks of metabolic complications and availability of suitable solutions. However, interest persists in citrate anticoagulation as a viable alternative when heparin is either contraindicated or has failed to provide an adequate circuit lifespan due to dialyser clotting. ⋯ This paper describes a practical protocol for the delivery of regional citrate anticoagulation for pre-dilutional CVVHDf. The protocol maintains the flexibility in dialysis/haemofiltration dose prescription and advises on the requirement for monitoring and necessary adjustments to prevent the development of metabolic disturbances. This may assist regional citrate to achieve wider acceptance as an alternative anticoagulation strategy for critically ill patients.
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The Intensive Care Collaborative project was established with the specific aim of developing recommendations for clinical practice that are underpinned by the best available evidence to support the objective of improving the standard of care delivered in NSW Intensive Care Units. The eyecare clinical practice guideline for intensive care patients were developed as a result of this initiative. ⋯ The recommendations from this clinical practice guideline were peer-reviewed and examined by ophthalmology experts. Despite the heavy reliance on only a small number of studies and low level of evidence, the recommendations have the potential to positively affect patient outcomes by encouraging clinicians to assess and monitor for ophthalmological complications and to provide appropriate preventative interventions if implemented extensively.
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To determine the frequency of medication errors that occurred during the preparation and administration of IV drugs in an intensive care unit. ⋯ Since our system is devoid of a well-organized reporting system, errors are not detected and consequently not prevented. Administrators need to take the initiative of developing systems that guarantee safe medication administration.