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201710282

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UWHC,UWMF,

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Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Order Sets,Inpatient,GI/Renal

IP - CRRT - Pediatric - Procedure [3622]

IP - CRRT - Pediatric - Procedure [3622] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, GI/Renal


IP - CRRT - Pediatric - Procedure [3622]
Patient Care Orders
Monitoring Parameters [80596]
Measure Weight with AM Vitals [NURMON0015] 1X DAILY, Starting today, Routine
Weigh With?
Weigh when? AM
Contingency Parameters [80597]
Notify Pediatric Nephrologist [NURCOM0001] Provider to Notify: Other (Comment)
If systolic blood pressure > (mmHg): ***
If systolic blood pressure < (mmHg): ***
If diastolic blood pressure > (mmHg):
If diastolic blood pressure < (mmHg):
If temperature > (C):
If temperature < (C):
If heart rate > (bpm):
If heart rate < (bpm):
If respiratory rate >:
If respiratory rate <:
If blood glucose > (mg/dL):
If blood glucose < (mg/dL):
If pain score >:
Pulse Oximetry < (%):
If urine output < (mL):
Other: Bleeding
DO NOT interrupt CRRT procedure and/or DO NOT
transport patient on CRRT without first consulting with
Peds Nephrologist on call.
Notify Dialysis Staff [228108]
Notify Dialysis Staff [NURCOM0022] ONCE, For problems or questions contact Dialysis
Staff at 263-8748 Monday-Saturday 0800-1830. After
hours use pager 0029.
Citrate Anticoagulation Contingency Parameters [80598]
Notify Pediatric Nephrologist if Ionized Calcium
Lab Value is Less Than 3.9 or Greater Than 6.0
mg/mL [NURCOM0022]
CONTINUOUS, Starting today For Until specified
Procedure Management - General
Procedure Management: CRRT [80601]
Continuous Renal Replacement Therapy (CRRT)
- Pediatric [DIAL0004]
CONTINUOUS, Starting today, Routine
Modality:
Cartridge Plus Filter:
Blood Flow Rate (QB mL/minute. Recommended rate
4-6 mL/kg/minute)(mL/hour):
Net Ultrafiltration Rate:
Fluid/Electrolyte Replacement: Pre-Filter
Filter Flushes [80616]
sodium chloride 0.9% BOLUS [730003] 50-200 mL, Other, EVERY 1 HOUR PRN, CRRT
system flush as needed
Observe for clots in hemofilter and venous trap. Add
flush volume into UFR calculations. Calculating flush
volume for system: HF400= 83 ml, HF700= 108 ml,
Adult filter = 171 ml.
Standard Prime - Pediatric Aliquot Packed Red Blood Cells - (Consider Using Blood Prime if Total Blood
Prime is Greater Than 7 mL/kg) [80617]
Page 1 of 5
Printed by WILLIAMS, HEATHER R [HRS0] at 10/2/2017 12:21:23 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 10/2017CCKM@uwhealth.org

NOTE: Hold citrate anticoagulation for blood
prime [950018]
2 X DAILY
Inpatients who require blood prime for CRRT, avoid
the use of citrate for the first 15 minutes, as it may
exacerbate bradykinin release syndrome
sodium chloride 0.9% BOLUS [730003] Intravenous, ONCE For 1 Doses
Standard prime for CRRT treatment
albumin human 5% infusion [44038] Intravenous, ONCE For 1 Doses
Hang to gravity. Albumin tubing needed.
Standard prime for CRRT treatment
Use Reconstituted Blood to Prime System. See
Blood Orders for Reconstituted HCT and Volume
[NURTRT0048]
SEE COMMENTS, Starting today, As needed for
system clotting
Red Blood Cells (Pediatric) [BLB0013] 1 UNIT, Starting today For 1 Occurrences, Routine
If ordering < 1 unit specify the Total Volume to be
transfused (mL):
Reason for Order: PR10 Other
Specify Other Reason: CRRT procedure
Blood Product Need (It will take approximately 30 to
60 minutes from the time nursing notifies the Blood
Bank to prepare the products):
Date Product Needed:
Uncrossmatched **WARNING** Requesting MD
verifies that the clinical situation is sufficiently urgent
to require release of blood before completion of
compatibility testing and agrees to hold UWHC
harmless for any and all liability for any injuries
resulting from release of blood before such testing:
Irradiated (See Blood Product Guidelines) (May be
pre-selected based on history):
CMV Negative (Heart/Lung Transplant and Neonates
up to 4 Months Only) (May be pre-selected based on
history):
Volume-Reduced (May be pre-selected based on
history):
Consent Status:
CRRT - Please write volume on blood product bag
Reconstituted Whole Blood volume (approximate
volume required to prime circuit: *** and product HCT:
***
Calculating Prime Volume (mL):
Adult filter - 171 mL
HF1200 - (83+55=138 mL)
HF700 - (53+55=108 mL)
HF400 - (28+55=83 mL)
Rinseback Instrutions [NURCOM0022] ONCE, Rinseback total volume: ***
Standard Prime - Adult Aliquot Packed Red Blood Cells - (Consider Using Blood Prime if Total Blood
Prime is Greater Than 7 mL/kg) [186009]
NOTE: Hold citrate anticoagulation for blood
prime [950018]
2 X DAILY
Inpatients who require blood prime for CRRT, avoid
the use of citrate for the first 15 minutes, as it may
exacerbate bradykinin release syndrome
sodium chloride 0.9% IV BOLUS [730003] Intravenous, ONCE For 1 Doses
Standard prime for CRRT treatment
albumin human 5% infusion [44038] Intravenous, ONCE For 1 Doses
Hang to gravity. Albumin tubing needed.
Standard prime for CRRT treatment
Page 2 of 5
Printed by WILLIAMS, HEATHER R [HRS0] at 10/2/2017 12:21:23 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 10/2017CCKM@uwhealth.org

Use Reconstituted Blood to Prime System. See
Blood Orders for Reconstituted HCT and Volume
[NURTRT0048]
SEE COMMENTS, Starting today, As needed for
system clotting
Red Blood Cells (Adult) [BLB0006] 1 UNIT, Starting today For 1 Occurrences, Routine
Reason for Order: R8 Other
Specify Other Reason: CRRT procedure
Blood Product Need (It will take approximately 30 to
60 minutes from the time nursing notifies the Blood
Bank to prepare the products):
Date Product Needed:
Uncrossmatched **WARNING** Requesting MD
verifies that the clinical situation is sufficiently urgent
to require release of blood before completion of
compatibility testing and agrees to hold UWHC
harmless for any and all liability for any injuries
resulting from release of blood before such testing:
Irradiated (See Blood Product Guidelines) (May be
pre-selected based on history):
CMV Negative (Heart/Lung Transplant and Neonates
up to 4 Months Only) (May be pre-selected based on
history):
Consent Status:
Washed Product (Requires pathology review, call 263-
8367):
CRRT - Please write volume on blood product bag
Reconstituted Whole Blood volume (approximate
volume required to prime circuit: *** and product HCT:
***
Calculating Prime Volume (mL):
Adult filter - 171 mL
HF1200 - (83+55=138 mL)
HF700 - (53+55=108 mL)
HF400 - (28+55=83 mL)
Rinseback Instructions [NURCOM0022] ONCE, Rinseback total volume: ***
Procedure Management - Replacement Fluids With Citrate Anticoagulation
bicarbonate Consider holding bicarbonate replacement fluids if on citrate and serum NOTE:
greater than 35 mEq/L
Replacement [80619]
Note: CRRT Replacement Fluid Parameters
[950033]
4 X DAILY (NOTE ACKNOWLEDGE)
Standard replacements rate = 2000-3000 mL/hr per
1.73 meters squared. Total replacement fluid rate:
***mL/hr
Custom Replacement Fluids [233464]
Note: CRRT Custom Replacement Fluids - Saline
Bag - with Additives [950018]
CONTINUOUS
Sodium chloride 0.9% with potassium chloride ***
mEq/L
NOTE: CRRT Custom Replacement Fluids -
Sterile Water Bag - with Additives [950018]
CONTINUOUS
Sterile water with sodium bicarbonate 75 mEq/L,
dextrose 3.75 g/L, and sodium chloride 50mEq/L
NOTE: CRRT Replacement Fluids - 3L Saline
bag - withOUT Additives [950018]
CONTINUOUS
3L bag sodium chloride 0.9 %. Arterial side of system.
Separate port.
(PEDS ONLY) CRRT soln K 4 mEq, bicarb 22
mEq, Ca 0mEq, Na 140mEq HPO 1 mmol
(PHOXILLUM B22K4/0) stock bag [171813]
CRRT, CONTINUOUS
Replacement
Page 3 of 5
Printed by WILLIAMS, HEATHER R [HRS0] at 10/2/2017 12:21:23 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 10/2017CCKM@uwhealth.org

CRRT soln K 2mEq, bicarb 25mEq, Ca 0mEq, Na
130mEq (NX STAGE RFP453-K 2 mEq/L) stock
bag [785126]
CRRT, CONTINUOUS
Replacement
CRRT soln K 4mEq, bicarb 25mEq, Ca 0mEq, Na
130mEq (NX STAGE RFP454-K 4 mEq/L) stock
bag [785127]
CRRT, CONTINUOUS
Replacement
Dialysate [230418]
CRRT soln K 2mEq, bicarb 25mEq, Ca 0mEq, Na
130mEq (NX STAGE RFP453-K 2 mEq/L) stock
bag [785126]
CRRT, CONTINUOUS
Dialysate
CRRT soln K 4mEq, bicarb 25mEq, Ca 0mEq, Na
130mEq (NX STAGE RFP454-K 4 mEq/L) stock
bag [785127]
CRRT, CONTINUOUS
Dialysate
Anticoagulation Management [80611]
anticoagulant citrate formula A (PEDIATRIC) -
NOTE: Recommended initial rate 1.5-2 times
blood flow rate, e.g. BFR 150 mL/min x2 = ACD-A
at 300 mL/hr [52645]
CRRT, CONTINUOUS
Initiate at *** mL/hr (NOTE: Recommended initial rate
1.5-2 times blood flow rate, e.g. BFR 150 mL/min x2 =
ACD-A at 300 mL/hr)
Administer on arterial side of system with T connector
Adjust citrate according to post-filter ionized calcium
according to the following schedule:
If 0.9-1.1 mEq/L, decrease by 5 mL/hr;
If 1.2-1.8 mEq/L, no change in infusion;
If 1.9-2.3 mEq/L, increase by 5 mL/hr
calcium-magnesium Continuous Renal
Replacement Therapy bag - NOTE:
Recommended initial rate 0.5 times rate of citrate
infusion. Administer via Central line [700302]
at 5-200 mL/hr, Intravenous, CONTINUOUS
Administer via CENTRAL LINE
Initiate at *** mL/hr
Adjust according to peripheral ionized calcium results
If less than 3.9 mg/dL, increase by 15 mL/hr, give
calcium gluconate per PRN order and notify
nephrologist;
If 3.9-4.29 mg/dL, increase by 10 mL/hr;
If 4.3-4.69 mg/dL, increase by 5 mL/hr;
If 4.7-5.4 mg/dL no change;
If 5.41-5.7 mg/dL, decrease by 5 mL/hr;
If 5.71-6.0 , decrease by 10 mL/hr;
If over 6.0 mg/dL, decrease by 15 mL/hr and notify
nephrologist
STOP CITRATE INFUSION IF CALCIUM-
MAGNESIUM INFUSION IS STOPPED FOR
GREATER THAN 5 MINUTES
NOTE: Recommended initial rate 0.5 times rate of
citrate infusion
calcium GLUConate injection - NOTE: Suggested
dose 100 mg/kg (Maximum dose 2g) [800105]
100 mg/kg, Intravenous, PRN, peripheral ionized
calcium less than 3.9 mg/dL
CRRT
Procedure Management - Replacement Fluids withOUT Citrate Anticoagulation
Replacement [100544]
Note: CRRT Replacement Fluid Parameters
[950033]
4 X DAILY (NOTE ACKNOWLEDGE)
Standard replacements rate = 2000-3000 mL/hr per
1.73 meters squared. Total replacement fluid rate:
***mL/hr
Custom Replacement Fluids [233467]
Page 4 of 5
Printed by WILLIAMS, HEATHER R [HRS0] at 10/2/2017 12:21:23 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 10/2017CCKM@uwhealth.org

Note: CRRT Custom Replacement Fluids - Saline
Bag with Additives [950018]
CONTINUOUS
Sodium chloride 0.9% with potassium chloride ***
mEq/L
Note: CRRT Custom Replacement Fluids -
Sterile Water Bag with Additives [950018]
CONTINUOUS
Sterile water with sodium bicarbonate 75 mEq/L and
dextrose 3.75 g/L
Note: CRRT Custom Replacement Fluids -
Calcium Bag [950018]
CONTINUOUS
Sodium chloride 0.9% with calcium chloride 7.5
mEq/L and magnesium sulfate 5 mEq/L
NOTE: Do NOT order with citrate anticoagulation
Note: CRRT Replacement Fluids - 3L Saline Bag
- withOUT additives [950018]
CONTINUOUS
3 L Bag Sodium Chloride 0.9%. Arterial side of
system. Separate port.
CRRT soln K 4mEq, bicarb 35mEq, Ca 3mEq, Na
140mEq (NX STAGE RFP401-K 4 mEq/L) stock
bag SOLN [785051]
CRRT, CONTINUOUS
Replacement
CRRT soln K 0mEq, bicarb 35mEq, Ca 3mEq, Na
140mEq (NX STAGE RFP402) stock bag SOLN
[785052]
CRRT, CONTINUOUS
Replacement
Dialysate [232158]
CRRT soln K 4mEq, bicarb 35mEq, Ca 3mEq, Na
140mEq (NX STAGE RFP401-K 4 mEq/L) stock
bag SOLN [785051]
CRRT, CONTINUOUS
Dialysate
CRRT soln K 0mEq, bicarb 35mEq, Ca 3mEq, Na
140mEq (NX STAGE RFP402) stock bag SOLN
[785052]
CRRT, CONTINUOUS
Dialysate
Anticoagulation [232160]
Therapeutic Dosing of Unfractionated Heparin -
Pediatric/Neonatal - Inpatient Clinical Practice
Guideline
URL: https://uconnect.wisc.edu/clinical/cckm-
tools/content/cpg/hematology-and-
coagulation/name-97526-en.cckm
Note: Heparin anticoagulation as per Peds ICU
staff [950018]
ONCE For 1 Doses
Medications
Electrolyte Replacement [230046]
phosphate POTASSIUM intraVENOUS PEDS
CENTRAL [800211]
0.24 mmol, Intravenous, EVERY 6 HOURS
Laboratory
Lab Schedule Communication with Primary Team and Nursing [230463]
CRRT Lab Schedule [NURCOM0052] CONTINUOUS, Routine
Order Name (Only necessary if something other than
"Nursing Communcation" is preferred.):
For ALL CRRT patients, draw these labs 2 hours after
Initiation, then again in 6 hours, and then every 8
hours= LYTE, BUN, CRET, GLU, MAG, PHOS,
IONIZED CALCIUM WHOLE BLOOD. For CRRT
patients getting citrate anticoagulation add these
additional labs 2 hours after Initiation, then again in 2
hours, and then every 4 hours= CALCIUM, IONIZED
CALCIUM WHOLE BLOOD, IONIZED CALCIUM
WHOLE BLOOD POST FILTER
Page 5 of 5
Printed by WILLIAMS, HEATHER R [HRS0] at 10/2/2017 12:21:23 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 10/2017CCKM@uwhealth.org