CVVH/CVVHDF Prescription Addressograph

Vascath size and length:
Vascath lumen volume
* refer to vascath bundle and drug chart
Red lumen mls
Blue lumen mls
* heparin for hep-lock must be prescribed on drug chart

Date: from 12.00 ___/___/___ to 12.00 ___/___/___

Weight:

Allergies:

Circle treatment option
CVVH / CVVHDF
Initial Prime of Circuit / Nurse 1 (sign + print) / Nurse 2 (sign + print)
Heparin 5000units / 1 litre 0.9% sodium chloride
(not delivered to patient)
Priming Fluid
Prescribe blood product on All Wales
Transfusion Chart / Dr’s Signature
(sign + print) / Nurse 1
(sign + print) / Nurse 2
(sign + print)
0.9% Sodium Chloride
4.5% Human Albumin Solution
(if < 20kg)
*If patient < 10kg consider the need for packed red cells directly to patient

ANTICOAGULATION (HEPARIN)

Heparin - 125 Units / kg (0.125ml/kg of 1000U/ml heparin) made up to 50mls with 0.9% Sodium Chloride so that 1ml /hr = 2.5 units/kg/hr.
Heparin ……………… Units in 0.9% sodium chloride 50 mls.
(= …………ml of 1,000 Units / ml)
(run according to the guidance overleaf)
Doctor’s signature (sign + print)
Time / Nurse 1 (sign + print) / Nurse 2 (sign + print) / Time / Nurse 1 (sign + print) / Nurse 2 (sign + print)
1) / 3)
2) / 4)
START UP ANTICOAGULATION (HEPARIN)
Baseline ACT: ………
* This should be performed within 4 hours of treatment from a non-heparinised line
ACT < 180 seconds – Bolus 10 Units/kg of Heparin
Infusion 10 Units/kg/hour (run at 4mls/hour)
ACT > 180 seconds – Bolus no bolus required
Infusion 5 Units/kg/hour (run at 2 mls/hour)
Heparin bolus:………… units/kg
* Heparin bolus to be given into red port pre-filter
Heparin infusion rate: ……….. units/kg/hour / Doctor’s signature (sign + print)
Nurse 1 (sign + print) / Nurse 2 (sign + print)
ONGOING ANTICOAGULATION (HEPARIN)
Maintain ACT between 160 and 180 seconds - sample ACT from blue port (post-filter)
ACT < 160 seconds – increase heparin infusion by 2ml (5 units / kg) / hour
ACT > 180 seconds – decrease heparin infusion by 2ml (5 units / kg) / hour

ANTICOAGULATION IF HEPARIN CONTRAINDICATED:

EPOPROSTENOL
500 micrograms in 50ml 0.9% sodium chloride - Start at 3 nanograms/kg/minute and adjust as needed
(maximum 10 nanograms/kg/minute)
(0.06ml/kg/hr = 10 nanograms/kg/min.)
Epoprostenol infusion rate: ……………. nanograms/kg/min.
= ……………. mls/hour / Doctor’s signature (sign + print)
Nurse 1 (sign + print) / Nurse 2 (sign + print)

PROGRAMME

Blood Flow Rate - * Guidance can be found in CRRT prescription guide
Start at ……….. ml/minute
(half of minimum BFR) / Increasing as tolerated to ……….. ml/minute
* This should be as quick as possible to prevent filter clotting
Substitution fluid rate
*Usually ⅓ pre dilution, ⅔ post dilution / mls/hr / Dr’s signature
(sign + print) / Nurse 1
(sign + print) / Nurse 2
(sign + print)
Total Rate (refer to guidance)
Pre Blood Pump (pre-dilution)
Replacement (post-dilution)
Dialysate flow rate

PROGRAMME CHANGE

Substitution fluid rate
*Usually ⅓ pre dilution, ⅔ post dilution / mls/hr / Dr’s signature
(sign + print) / Nurse 1
(sign + print) / Nurse 2
(sign + print)
Total Rate (refer to guidance)
Pre Blood Pump (pre-dilution)
Replacement (post-dilution)
Dialysate flow rate

PATIENT FLUID REMOVAL RATE

Time / Fluid Loss Rate or Even Balance / Dr’s signature
(sign + print) / Nurse 1
(sign + print) / Nurse 2
(sign + print)
1)
2)
3)
4)
5)
6)

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CVVH/CVVHDF Prescription Addressograph

SUBSTITUTION FLUID

The prescribed substitution fluid is to be used for the pre-blood pump, replacement and dialysate lines.

If CVVHDF is not used attach a 1L bag of 0.9% sodium chloride to the dialysate line (green line) and clamp line.

Additives to Hemosol B0 5 litre (important: 20mmol potassium in 5 litres is equivalent to 4mmol/litre (physiologically normal). If prescribed total potassium > 20mmol/L discuss with consultant)
Time / Potassium Acid Phosphate
1ml contains 1mmol phosphate and 1mmol potassium
(maximum 10ml per 5L bag) / Potassium Chloride
1ml contains 2mmol of potassium / Dr’s signature / *substitution fluid must changed every 24hrs
Start time / Given/ Set up by / Checked by / Start time / Given/ Set up by / Checked
by
1)  / mmol in 5 L / mmol in 5 L
2)  / mmol in 5 L / mmol in 5 L
3)  / mmol in 5 L / mmol in 5 L
4)  / mmol in 5 L / mmol in 5 L
5)  / mmol in 5 L / mmol in 5 L
6)  / mmol in 5 L / mmol in 5 L
7)  / mmol in 5 L / mmol in 5 L
8)  / mmol in 5 L / mmol in 5 L
9)  / mmol in 5 L / mmol in 5 L
10)  / mmol in 5 L / mmol in 5 L

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CVVH/CVVHDF Prescription Addressograph

STANDARD FLOW RATES

Weight / Total substitution rate (mls/hr) / Dialysate flow rate (mls/hr) / Min. blood flow rate (BFR) (mls/min) / Max. blood flow rate (BFR) (mls/min)
2.5 / 75 / 50 / 20 / 30
5 / 150 / 100 / 30 / 45
10 / 300 / 200 / 60 / 90
15 / 450 / 300 / 90 / 120
20 / 600 / 400 / 120 / 150
25 / 750 / 500 / 150 / 180
30 / 900 / 600 / 180 / 240
35 / 1050 / 700 / 180 / 240
40 / 1200 / 800 / 180 / 240
45 / 1350 / 900 / 180 / 240
50 / 1500 / 1000 / 180 / 240
The machine will allow blood flow speeds up to maximum of 400mls/min, but this is often not achievable or necessary

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CVVH/CVVHDF Daily Prescription Addressograph

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