Dynamics (Pembroke, Ont.)
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Dynamics (Pembroke, Ont.) · Jan 2001
ReviewAnticoagulation in continuous renal replacement therapy.
Continuous renal replacement therapy (CRRT) is a specialized intervention that is managed largely by critical care nurses who are educated in the theoretical and practical aspects of the therapy. CRRT is most commonly indicated for hemodynamically unstable patients who have acute renal failure and a narrow margin of tolerance for the rapid fluid shifts associated with traditional dialysis. ⋯ Nurses at the bedside must be expert in both managing CRRT and assisting in identifying patients who may be at potential risk when this form of treatment is in place. An overview of possible anticoagulants for use in CRRT is outlined in this article.
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Dynamics (Pembroke, Ont.) · Jan 2001
ReviewA review of neuromuscular blockade in the critically ill patient.
The continuous administration of neuromuscular blocking agents is thought to be associated with a number of adverse effects and complications, including post-paralytic syndrome (characterized by persistent paralysis), muscle weakness, and the inability to wean from the ventilator despite discontinuation of the therapy. Consequently, clinical objectives emphasize administering only the dose necessary to optimize the effect of the drug and for the shortest possible time. This article provides an overview of the administration of neuromuscular blocking agents, from the perspective of a critical care pharmacist and critical care nurses. The complexities associated with pharmacological paralysis in critically ill patients warrants the comprehensive approach to care that multidisciplinary team members can provide.
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Continuous renal replacement therapy is a treatment option that is especially suited to the critical care setting. Greater hemodynamic stability, the ongoing ability to optimize fluid balance, and the potential for clearing inflammatory mediators are among the frequently cited advantages continuous veno-venous dialysis modalities offer over traditional intermittent therapies. ⋯ The blood is then returned to the patient, without large fluctuations in electrolyte and acid-base balance or renal hypoperfusion. This article includes a review of acute renal failure, a discussion of the indications for continuous renal replacement therapy, the mechanisms of action of this therapy, and the nursing considerations.