1. health and fitness
2. therapy

Patient I.D. Label
Patient Care Orders
PRISMAFLEX CRRT orders
Heparin
Refer to previous CRRT orders. Please write firmly with a black ballpoint pen.
All orders must be signed by the physician. All co-signatures must be timed and dated within 24 hours.
Orders may be deleted by stroking the order out, initialing and dating the entry.
Patient estimated dry weight…………Kg
Orders
Prismaflex Filter Set
ST100
ST150
Mode
CVVH /////////////////////////////////////////////////////////////////////////
Priming Solution
Heparin 5000units/L
No heparin
Blood Flow Rate mL/min
200-450 mL/min
Other________
Replacement Solution Concentrations
Prism0cal
HCO3
32mmol/L
42mmol/L
52mmol/L
Potassium chloride …….. mmol/L (whole numbers only)
Do not thin from chart
Comments/Suggestions
The ST100 hemofilter is the standard filter for adult CRRT. ST150 hemofilter
is used when high blood flow is required. This membrane is surface treated
and adsorbs heparin.
Use CVVH when using heparin as anticoagulant or no anticoagulant as
predilution CVVH may increase hemofilter life.
Use of heparin in priming solution will allow heparin binding to the surface
treated membrane and further reduce risk of clotting.
Adjust blood flow depending on normal access and return pressures.
Higher blood flows are associated with better clearance and filter life.
Prism0cal with compartment A added to B contains (mmol/L): Na 140, Cl 106,
Mg 0.5, lactate 3, HCO3 32. Addition of the HCO3 pouch provides HCO3 32
mmol/L. Addition of more NaHCO3 increases the HCO3 concentration by 10
mmol/L for each 50 mmol added.
Calcium must be added unless contraindicated e.g. hypercalcemia.
Calcium chloride 1 gm (10 mL) per 5 Litre bag
Total Replacement Pump Rate mL/h
2000
2500
3000
Other________
% Prefilter
50%
Other ……………(to max 90%)
Patient Fluid Removal Rate:............... mL/h
Include
Urine
Gastric
Drains
Heparin Bolus into pre-filter circuit
No bolus
……………units
Anticoagulant- Pre Blood Pump (PBP)
Heparin Infusion, start at……………..units/h
Replacement solution is used for hemofiltration (convective clearance of
solutes). The total fluid that is used/hour (effluent) is considered the dose of
hemofiltration and is normally between 25-30 mL/kg/h depending on
percentage pre-filter (higher prefilter requires higher volume for same solute
clearance), patient acuity and circuit downtime. Dose should be modified
frequently based on patient urea and creatinine levels and acid base status.
The replacement fluid may be infused pre-filter or post-filter. Pre-filter
decreases the viscosity of the blood and lessens risk of circuit clotting but
reduces solute clearance. Post-filter hemofiltration improves solute
clearance. At least 10% must be infused post-filter to provide a fluid/blood
interface in the de-aeration chamber.
Enter the patient fluid removal rate hourly on the Prismaflex System:
Patient fluid removal =(Net fluid removal rate + IV intake) - Output
Usually 50-100 units/kg. Give bolus via the red injection port on the access
line closest to patient.
Hang Heparin infusion bag on PBP scale. Usually commence at 10-15
units/kg/h and then monitor ACT/PTT.
Heparin bag: 5000 units/1000mL = 5 units per mL.
Usually aim for ACT between 160 and 180 seconds or PTT 60-110 seconds.
Draw blood for ACT/PTT from the blue injection port (post filter).
Anticoagulation monitoring:
ACT q…....h until stable then Q 6h
PTT q …..h until stable then Q 6h
Laboratory Monitoring
Electrolytes
Q 8h
Q 12h
Urea, Cr, Mg, P04: q 24h
Daily CBC (for hematocrit)
other___________________________
Orders to be completed on a Daily Basis (minimum requirement)
Physician Signature:_____________________________________________Date/Time_____________
(Residents/Fellows must confirm orders with the ICU Attending Physician)
Prismaflex/HEPARIN Revised May 2015
HEPARIN NOMOGRAMS
(1) Monitoring PTT
PTT
<45 secs
45 – 59 secs
61 – 110 secs
111 -115 secs
116 – 120 secs
121 – 125 secs
> 125 secs
BOLUS
3000 units
0
0
0
0
0
0
DOSAGE CHANGE+
+100 units/h
+50 units/h
0
-50 units/h
-100 units/h
-150 units/h
-300 units/h
PTT after restart of Heparin
Note:
P.T.T. obtained from venous side (post-filter) of Prismaflex circuit.
Document on Physician’s Order Sheet time for next PPT
Obtain PTT 2 hours after each dosage change.
When P.T.T. 55–80 secs check P.T.T. q4h X 2, then q6h.
Document changes in dosage.
(2) Monitoring ACT
The optimal goal range for the ACT is between 160 to 200 seconds unless the hemofilter had previously clotted at this
range
ACT Level
Change in Heparin Infusion Rate
< 160 seconds
Increase rate by 500 units / hour and re-bolus with 1000 units.
161 – 200 seconds
No change to rate.
> 200 seconds
Stop heparin infusion for 60 minutes,
then restart at 250 units / hour less than the previous rate.
Please note the ACT must be rechecked 60 minutes following each subsequent intervention.
CRRT Dosing Nomogram
Weight
25 ml/kg/h
30 ml/kg/h
50
1250
1500
60
1500
1800
70
1750
2100
80
2000
2400
90
2250
2700
100
2500
3000
110
2750
3300
120
3000
3600
Prismaflex/HEPARIN Revised May 2015