Docstoc

NTUH SICU Pediatric dialysis guideline

Document Sample
NTUH SICU Pediatric dialysis guideline Powered By Docstoc
					                       NTUH SICU Pediatric dialysis guideline
                                                                             2009 年 6 月 7 日
1. Indication for pediatric RRT (renal replacement treatment):
    (1). Acute renal failure:
          □azotemia (BUN: ≧ 80 mg/dL, Cre: ≧ 4mg/dL)
          □Fluid overload (CVP≧12 mmHg) unresponsive to diuretics
          □electrolyte imbalance ( K+ > 5.5 mmol/L)
          □Acid-base imbalance (HCO3- <15 mmol/L, or pH< 7.25)
         □Oliguria (<0.5 mL/kg/hr) > 12 hours, anuria > 6 hours
         □Other:要說明理由
   (2). end stage renal diseases
2. 符合條件者,由 ICU VS 決定要不要洗,並開處方。若有爭議,須和手術醫師協調。
3. 同一次住院第一次接受透析治療要有同意書。
4. 能執行血液透析的兒科病患,比照 NTUH SICU Adult dialysis guideline
5. 外科加護病房兒科的透析(P/D or CVVH)由加護病房護理人員執行,CAVH in ECMO
   及 HD 則由外科技術員或單位專科護理師執行。
6. 執行血液透析人員(Technician, NP),參加腎臟醫學會上課受訓,取得腎臟醫學會血液
   透析護理人員證照。每年接受學會在職教育,維持有效証照。
7. Monitoring
   □ Hourly monitoring:consciousness, HR, BP, RR, CVP
   □ Daily monitoring ( dialysis day only):BW、K+、Ca+2、Sugar
   □ Q1, 4:BUN、Cre,Phosphate、Mg
   □ QW1:Albumin
   □ Nutrition:protein ≧ 1.5gm/Kg/day in ARF
   □ 要記錄 Dialysis Note

8. NTUH SICU RRT Modality
    (1). PD:Peritoneal dialysis
          a. Indication:符合小兒腎臟替代治療之適應症之病患,腹部手術除外
          b. Setting:
                                          :                        :
             (a). Insert Tenckhoff catheter prophylactic antibiotics at least cephalosporin 20mg/kg IV
                  st
              (b). Dialysate solution:Glucose 1.5% 為主,視情況改用較高濃度。
              (c). Cefuroxime 125mg/L in the dialysis fluid for 48hr (Zinacef 375mg / PD
              solution)
              (d). Heparin 500unit/L should be add to dialysis fluid to prevent catheter
                    blockage with fibrin and improve peritoneal solute permeability
              (e). Dialysis fill volumes : 10 ~ 20ml/Kg
     c. Retention 1hr each cycle, shorter retention if hyperkalemia
     d. Additional monitor for P/D complications q8h
         (a). Leakage
         (b). Poor draining: mechanical blockage or catheter migration is common
         (c). Hernia
         (d). Peritonitis
         (e). Measurement of IPP (Intraperitoneal pressure) if necessary


  (2). CVVH
       a. Indication:符合小兒腎臟替代治療之適應症之病患,且有適當之血管通路者
     b. Setting
         (a)    Dual-lumen choose
    Patients (Kg)   Vascular access             Machine                    A/K       Blood flow ml/min

    2.5 ~ 10        7.5 FG dual-lumen (10cm)    IMED infusion pump         HPH-400? 6 ~ 10
    10 ~ 20         11 Fr double lumen (15cm)   HF-400 ( Pediatric set )   AV-400    50 ~ 100

    > 20            12 Fr double lumen (15cm)   HF-400                     AV-600    150 ~ 200

              (b). Hemofiltration : 20 ~ 30ml/kg/hr
                                                                            +
              (c). Replacement fluid : pre-dilution, 信東 A+(B+Rolikcan),若病人「K 」低,
                   則每袋 B 液加 KCl (20 meq)一支
     c. Monitoring for CVVH complications:
          (a). Hypotension
          (b). Clotting of the filter

  (3). CAVH:
     a. Indication: ECMO patients with ARF requiring dialysis
     b. Blood flow by pressure gradient,目前無法測量
     c. ECMO Site : oxygenator access side port to negative pressure port
     d. Hemofiltration: 35ml/kg/hr
     e. dialyzer: HPH400
     f. Replacement fluid: pre-dilution, 信東 A+(B+Rolikcan),若病人「K+」低,則每
        袋 B 液加 KCl (20 meq)一支
     g. Monitoring: Clotting of the filter


9. SICU Nurse Training
   (1). CVVH set-up:包括裝機,設定,記錄,故障排除
  (2). P/D set-up:包括設定,記錄,故障排除
  (3). SICU CRRT 單位在職教育上課:包括
        a. 血液透析原理及臨床適應症
b.   急性腎衰竭之處理及各種血液透析模式的選擇

				
DOCUMENT INFO
Shared By:
Categories:
Stats:
views:82
posted:3/2/2011
language:Indonesian
pages:3