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/clinical/cckm-tools/content/order-sets/inpatient/girenal/name-98309-en.cckm

201709261

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IP – CRRT WITHOUT Citrate – Adult – Continuous Renal Replacement Therapy WITHOUT Citrate Anticoagulation – Procedure [5445]

IP – CRRT WITHOUT Citrate – Adult – Continuous Renal Replacement Therapy WITHOUT Citrate Anticoagulation – Procedure [5445] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, GI/Renal


IP - CRRT WITHOUT Citrate - Adult - Continuous Renal Replacement Therapy
WITHOUT Citrate Anticoagulation - Procedure [5445]
for Adult Patients OnlyIntended
Patient Care Orders
Monitoring Parameters [21748]
Measure Weight [NURMON0015] 1X DAILY, Starting today, Routine
Weigh With?
Weigh when?
Contingency Parameters [183333]
Notify Fellow [NURCOM0001] Provider to Notify: Other (Comment)
If systolic blood pressure > (mmHg): 180
If systolic blood pressure < (mmHg): 80
If diastolic blood pressure > (mmHg): 120
If diastolic blood pressure < (mmHg): 40
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: For emergency/hypotension (turn off
ultrafiltration), page fellow
Notify Dialysis Staff [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: For problems or questions contact Dialysis
Staff at 263-8748 Monday - Saturday 0800 - 1830.
After hours or no answer use pager 0029.
Procedure Management
CRRT Procedure [183334]
Page 1 of 4
Printed by WILLIAMS, HEATHER R [HRS0] at 9/13/2017 8:34:22 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 09/2017CCKM@uwhealth.org

Continuous Renal Replacement Therapy (CRRT)
- Adult [DIAL0008]
CONTINUOUS, Routine
Modality:
Cartridge/Filter: NxStage Cartridge and Dialyzer -
Adult
Blood Flow Rate (QB mL/minute. Range 100-600
mL/minute. Recommended Rate 250 mL/min): 250
Net Ultrafiltration Rate (mL/hour. Recommended
range 0-1000 mL/hour):
Therapy Fluid Location: Pre-Filter
CRRT Solutions with Calcium [116672]
NOTE: CRRT Solution Parameters - with Calcium
[950018]
EVERY 8 HOURS
Total CRRT fluid rate *** mL/hr (recommended rate
20-25 mL/kg/hr), Final potassium concentration in
CRRT solution ***, Total number of bags to hang 4
Bags WITH calcium
Number of bags of CRRT soln K 0 mEq, bicarb 35
mEq, Ca 3 mEq, Na 140 mEq (NX-STAGE RFP402):
***
Number of bags of CRRT soln K 4 mEq, bicarb 35
mEq, Ca 3 mEq, Na 140 mEq (NX-STAGE RFP401):
***
CRRT soln K 0mEq, bicarb 35mEq, Ca 3mEq, Na
140mEq (NX STAGE RFP402) stock bag SOLN
[785052]
CRRT, CONTINUOUS
Rate is Total CRRT fluid rate in mL/hr. Recommended
rate 20-25 mL/kg/hr. Rate is Total CRRT Fluid Rate
for all bags hung. Always hang 4 bags at the same
time and always check the note order for the correct
number of bags to hang of each type.
CRRT soln K 4mEq, bicarb 35mEq, Ca 3mEq, Na
140mEq (NX STAGE RFP401-K 4 mEq/L) stock
bag SOLN [785051]
CRRT, CONTINUOUS
Rate is Total CRRT fluid rate in mL/hr.Recommended
rate 20-25 mL/kg/hr. Rate is Total CRRT Fluid Rate
for all bags hung. Always hang 4 bags at the same
time and always check the note order for the correct
number of bags to hang of each type.
Supplemental Infusions [116697]
sodium bicarbonate 150 mEq in water (sterile)
1,200 mL infusion [700305]
Intravenous, CONTINUOUS
Infuse only while CRRT is running; stop when CRRT
not running
sodium chloride 0.9 % infusion [64367] Intravenous, CONTINUOUS
Infuse only while CRRT is running; stop when CRRT
not running
sodium chloride 0.45 % infusion [42187] Intravenous, CONTINUOUS
Infuse only while CRRT is running; stop when CRRT
not running
Phosphate Supplementation [117101]
phosphate-potassium & sodium (PHOS-NAK) oral
packet [112317]
2 packet, Dobhoff Tube, 4 X DAILY
Dilute in at least 70 mL of liquid Switch to IV if strict
NPO
Hold for phosphate >4 or potassium >5
phosphate SODIUM intraVENOUS SOLN
[800262]
15 mmol, Intravenous, EVERY 8 HOURS
Give every 8 hours if strict NPO
Hold for phosphate >4 or potassium >5
CRRT System Flushes [21757]
sodium chloride 0.9% BOLUS [730003] 100-200 mL, Other, EVERY 1 HOUR PRN, CRRT
Flush
Catheter Disconnection [116714]
Page 2 of 4
Printed by WILLIAMS, HEATHER R [HRS0] at 9/13/2017 8:34:22 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 09/2017CCKM@uwhealth.org

sodium chloride 0.9% flush 10 mL injection
[785055]
Flush, PRN, flush/line care
Flush each port of CRRT catheter prior to instilling
anticoagulant
anticoagulant citrate compound 4% injection
[785039]
1-3 mL, Intravenous, PRN, lock each port of CRRT
catheter when disconnecting per standard procedure
Administer after saline flush
heparin 1000 unit/mL 10mL vial STOCK VIAL
[790024]
1,000-3,000 units, Intravenous, PRN, lock each port of
CRRT catheter when disconnecting per standard
procedure
Administer after saline flush
Calcium Injection - As Needed [116702]
calcium CHLOride injection [35486] 1 g, Intravenous, PRN, serum ionized calcium less
than 3.8 mg/dL
Recheck Calcium, Ionized, Whold Blood and Calcium
in 4 hours
Laboratory
Lab Draw Instructions [181771]
Lab Draw Instructions [NURCOM0022] CONTINUOUS, Starting today, Draw these labs 4
hours after initiation of CRRT and then daily:
Electrolytes, Magnesium, Systemic Whole Blood
Ionized Calcium and Calcium. Draw these additional
labs daily: CBC, BUN, Phosphate and Creatinine. If
CRRT prescription is changed then restart sequence.
Draw at 4 hours after initiation and/or when CRRT prescription is changed [181784]
ELECTROLYTES [LYTE] CONDITIONAL - RN COLLECT, Starting today For 4
Weeks, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? Draw at 4 hours after
initiation and/or when CRRT prescription is changed
MAGNESIUM [MAG] CONDITIONAL - RN COLLECT, Starting today For 4
Weeks, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? Draw at 4 hours after
initiation and/or when CRRT prescription is changed
CALCIUM, IONIZED, WHOLE BLOOD
[HCWBICA]
CONDITIONAL - RN COLLECT, Starting today For 4
Weeks, STAT
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? Draw at 4 hours after
initiation and/or when CRRT prescription is changed
CALCIUM [CA] CONDITIONAL - RN COLLECT, Starting today For 4
Weeks, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? Draw at 4 hours after
initiation and/or when CRRT prescription is changed
Daily CRRT Labs [232357]
ELECTROLYTES [LYTE] CONDITIONAL - RN COLLECT, Starting today For 4
Weeks, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? Draw daily while
patient on CRRT
Page 3 of 4
Printed by WILLIAMS, HEATHER R [HRS0] at 9/13/2017 8:34:22 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 09/2017CCKM@uwhealth.org

MAGNESIUM [MAG] CONDITIONAL - RN COLLECT, Starting today For 4
Weeks, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? Draw daily while
patient on CRRT
CALCIUM, IONIZED, WHOLE BLOOD
[HCWBICA]
CONDITIONAL - RN COLLECT, Starting today For 4
Weeks, STAT
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? Draw daily while
patient on CRRT
CALCIUM [CA] CONDITIONAL - RN COLLECT, Starting today For 4
Weeks, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? Draw daily while
patient on CRRT
HEMOGLOBIN [HGB] CONDITIONAL - RN COLLECT For 4 Weeks, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? Draw daily while
patient on CRRT
HEMATOCRIT [HCT] CONDITIONAL - RN COLLECT For 4 Weeks, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? Draw daily while
patient on CRRT
BUN [BUN] CONDITIONAL - RN COLLECT For 4 Weeks, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? Draw daily while
patient on CRRT
CREATININE [CRET] CONDITIONAL - RN COLLECT For 4 Weeks, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? Draw daily while
patient on CRRT
PHOSPHATE [PHOS] CONDITIONAL - RN COLLECT For 4 Weeks, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? Draw daily while
patient on CRRT
Page 4 of 4
Printed by WILLIAMS, HEATHER R [HRS0] at 9/13/2017 8:34:22 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 09/2017CCKM@uwhealth.org