Unique Plan Description: Nephro CRRT
Plan Selection Display: Nephro CRRT
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2024-03-18 11:45:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2024-08-01 08:50:41
Available at all facilities: Yes

Nephro CRRT
Laboratory
	Hepatitis B Surface Antigen
		T;N, Routine, spec type = Blood
	Hepatitis B Surface Antibody
		T;N, Routine, spec type = Blood
	Hepatitis C Virus (HCV) Antibody with Rflx to PCR Confirmation
		T;N, Routine, spec type = Blood
	Protime - MH/WH/JE
		T;N, Timed, Q6H, spec type = Blood
	PTT - MH/WH/JE
		T;N, Timed, Q6H, spec type = Blood
	Basic Metabolic Panel
		T;N, Timed, Q6H, spec type = Blood
	Magnesium Level
		T;N, Timed, Q6H, spec type = Blood
	Ionized Calcium
		T;N, Timed, Q6H, spec type = Blood
	Phosphorus
		T;N, Timed, Q6H, spec type = Blood
	Hemogram
		T;N, Timed, Q6H, spec type = Blood
IV Solutions
	Sodium Chloride 0.9% CRRT Circuit Prime
		2,000 mL, IV Large Volume, Dialysis, Q1H, PRN dialysis, T;N
			Comment: Prime circuit with 1-2 liters as needed for CRRT
	Sodium Chloride 0.9% CRRT Flush
		1,000 mL, IV Large Volume, Dialysis, Q1H, PRN dialysis, T;N
			Comment: To attach to PrismaFlex dialysis machine for CRRT Flush. 200mL dialysis flush every hour as needed for CRRT. CRRT flush intake documentation to be done in CRRT flowsheet. Pharmacy - please product select NS 1000mL bag.
		Pre-Filter Replacement Fluid - White Scale(NOTE)*
	PrismaSOL BGK 4-2.5 - WHITE scale
		5,000 mL, Dialysis, ml/hr
			Comment: Pre-filter White scale, PrismaSOL 4/2.5. Contains potassium 4 mEq/L, calcium 2.5 mEq/L. RN to activate solution prior to administration.
	PrismaSOL BGK 5-2.5 - WHITE scale
		5,000 mL, Dialysis, ml/hr
			Comment: Pre-filter White scale, FINAL SOLUTION = PrismaSOL 5/2.5. Contains potassium 5 mEq/L, calcium 2.5 mEq/L. Pharmacy to activate solution upon dispensing
		5 mEq, EVERY BAG
	PrismaSOL BGK 3-2.5 - WHITE scale
		5,000 mL, Dialysis, ml/hr
			Comment: Pre-filter White scale, FINAL SOLUTION = PrismaSOL 3/2.5. Contains potassium 3 mEq/L, calcium 2.5 mEq/L (calcium chloride 920mg/bag). Pharmacy to activate solution upon dispensing
		920 mg, EVERY BAG
		5 mEq, EVERY BAG
	PrismaSOL BGK 2-2.5 - WHITE scale
		5,000 mL, Dialysis, ml/hr
			Comment: Pre-filter White scale, FINAL SOLUTION = PrismaSOL 2/2.5. Contains potassium 2 mEq/L, calcium 2.5 mEq/L (calcium chloride 920mg/bag). Pharmacy to activate solution upon dispensing.
		920 mg, EVERY BAG
		Dialysate - Green Scale(NOTE)*
	PrismaSATE BGK 4-2.5 - GREEN scale
		5,000 mL, Dialysis, ml/hr
			Comment: Dialysate Green scale, PrismaSATE 4/2.5. Contains potassium 4 mEq/L, calcium 2.5 mEq/L. RN to activate solution prior to administration.
	PrismaSATE BGK 5-2.5 - GREEN scale
		5,000 mL, Dialysis, ml/hr
			Comment: Dialysate Green scale, FINAL SOLUTION = PrismaSATE 5/2.5. Contains potassium 5 mEq/L, calcium 2.5 mEq/L. Pharmacy to activate solution upon dispensing.
		5 mEq, EVERY BAG
	PrismaSATE BGK 3-2.5 - GREEN scale
		5,000 mL, Dialysis, ml/hr
			Comment: Dialysate Green scale, FINAL SOLUTION = PrismaSATE 3/2.5. Contains potassium 3 mEq/L, calcium 2.5 mEq/L (calcium chloride 920mg/bag). Pharmacy to activate solution upon dispensing.
		920 mg, EVERY BAG
		5 mEq, EVERY BAG
	PrismaSATE BGK 2-2.5 - GREEN scale
		5,000 mL, Dialysis, ml/hr
			Comment: Dialysate Green scale, FINAL SOLUTION = PrismaSATE 2/2.5. Contains potassium 2 mEq/L, calcium 2.5 mEq/L (calcium chloride 920mg/bag). Pharmacy to activate solution upon dispensing.
		920 mg, EVERY BAG
		Post-Filter Replacement-Purple Scale(NOTE)*
	PrismaSOL BGK 4-2.5 - PURPLE scale
		5,000 mL, Dialysis, ml/hr
			Comment: Post-filter Purple scale, PrismaSOL 4/2.5. Contains potassium 4 mEq/L, calcium 2.5 mEq/L. RN to activate solution prior to administration.
	PrismaSOL BGK 5-2.5 - PURPLE scale
		5,000 mL, Dialysis, ml/hr
			Comment: Post-filter Purple scale, FINAL SOLUTION = PrismaSOL 5/2.5. Contains potassium 5 mEq/L, calcium 2.5 mEq/L. Pharmacy to activate solution upon dispensing.
		5 mEq, EVERY BAG
	PrismaSOL BGK 3-2.5 - PURPLE scale
		5,000 mL, Dialysis, ml/hr
			Comment: Post-filter Purple scale, FINAL SOLUTION = PrismaSOL 3/2.5. Contains potassium 3 mEq/L, calcium 2.5 mEq/L (calcium chloride 920mg/bag). Pharmacy to activate solution upon dispensing.
		920 mg, EVERY BAG
		5 mEq, EVERY BAG
	PrismaSOL BGK 2-2.5 - PURPLE scale
		5,000 mL, Dialysis, ml/hr
			Comment: Post-filter Purple scale, FINAL SOLUTION = PrismaSOL 2/2.5. Contains potassium 2 mEq/L, calcium 2.5 mEq/L (calcium chloride 920mg/bag). Pharmacy to activate solution upon dispensing.
		920 mg, EVERY BAG
	Sodium Bicarbonate 75 mEq/NS 0.45% 1000 mL - PURPLE scale
		75 mEq, EVERY BAG
		1,000 mL, Dialysis, ml/hr
			Comment: Post-filter Purple scale
	Sodium Bicarbonate 150 mEq/SWFI 1000 mL - PURPLE scale
		1,000 mL, Dialysis, ml/hr
			Comment: Post-filter Purple scale
		150 mEq, EVERY BAG
	Sodium Chloride 0.9% 1000mL - PURPLE scale
		1,000 mL, Dialysis, ml/hr
			Comment: Post-filter Purple scale
Medications
	HEParin 25,000 units/premixed diluent 250 mL
		250 mL, IV, 5 ml/hr
		25,000 units, EVERY BAG, 500 units/hr
	HEParin 1000 units/mL injectable soln
		500 units, Injection, IV Push, Once, STAT
	sodium citrate 4% PF injection
		3 mL, Injection, Catheter, POST-DIALYSIS, PRN see comment, T;N
			Comment: At end of CRRT, Instill volume sufficient to fill Arterial catheter lumen, discard remainder
		3 mL, Injection, Catheter, POST-DIALYSIS, PRN see comment, T;N
			Comment: At end of CRRT, Instill volume sufficient to fill Venous catheter lumen, discard remainder
	calcium gluconate IVPB
		2 gm, INT, IVPB, Q8H, PRN see comment
			Comment: if ionized calcium <1.
	sodium phosphate IVPB
		20 mmol, INT, IVPB, Q8H, PRN, see comment, 42 ml/hr, Infuse Over 6 hr
			Comment: If phosphorus < 2.5 mg/dL
	potassium phosphate IVPB
		0.08 mmol/kg, INT, IVPB, Once, PRN, see comment, Infuse Over 8 hr
			Comment: Notify MD prior to giving IF sodium phosphate is NOT available, if phosphorus < 2.5mg/dL and K < 4.5mMol/L.  MAX dose of 10mMol.
	magnesium sulfate IVPB
		2 gm, INT, IVPB, Q8H, PRN see comment, 25 ml/hr
			Comment: If magnesium is <1.8mg/dL.
Patient Care
	Continuous Renal Replacement Therapy
		T;N
	Vital Signs/Hemodynamic Monitoring
		T;N, Monitor and record CRRT readings hourly
	Intake and Output
		T;N, Q1H
	Notify
		T;N, Contact dialysis nurse for machine issues & troubleshooting needs.
	Notify MD
		T;N, If BP <____________
	Obtain Consent/Permit for:
		Dialysis
Consults/Follow-up
	Pharmacy Consult
		T;N, Pharmacokinetics, for dosing antibiotics

Heparin Non DVT/PE (Low dose) PTT Monitoring
Admit/Discharge/Transfer
		This plan is to be used for patients with the following diagnoses: atrial fibrillation, chest pain, stroke, MI(NOTE)*
Laboratory
	INR - MH/WH/JE
		Stat, spec type = Blood
	PTT - MH/WH/JE
		Stat, spec type = Blood
		T;N+360, Timed, Q6H, spec type = Blood
IV Solutions
	HEParin 25,000 units/premixed diluent 250 mL
		250 mL, IV
			Comment: conc: 100 units/mL. Titrate according to Low Dose Weight Based Heparin Protocol.  Maximum weight for dosing 110kg.  MAXIMUM INITIAL rate is 1000 units per hr.1)  PTT < 52 seconds, bolus 60 units/kg & increase rate by 4 units/kg/hr.2)  PTT = 52-64 seconds, bolus 30 units/kg & increase rate by 2 units/kg/hr.3)  PTT = 65-110 seconds, (therapeutic range) Do not give bolus & do not change rate.4)  PTT = 111-135 seconds, do not bolus. Decrease rate by 2 units/kg/hr.5)  PTT = 136 seconds or more, do not give bolus. Stop infusion for 60 mins & decrease rate by 3 units/kg/hr.Upper hard limits for weight based and non-weight based infusions are as follows: 40 units/kg/hour and 3000 units/hour, respectively; if patient needs require exceeding these limits, contact pharmacy and prescriber
		25,000 units, EVERY BAG, 12 unit/kg/hr
Medications
	HEParin 1000 units/mL injectable soln
		60 units/kg, Injection, IV Push, Once, STAT
			Comment: Dose = 60 units/kg Bolus.  Patient on Low Dose Heparin Protocol.  Pharmacy to calculate dose.  Begin heparin bolus and infusion immediately after initial stat labs are drawn.  (MAXIMUM INITIAL bolus = 4000 units)
		60 units/kg, Injection, IV Push, Q6H, PRN for see comment, T;N+360
			Comment: Dose = 60 units/kg Bolus. PTT level < 52 seconds, Patient on Low Dose heparin Protocol.  Pharmacy to calculate dose.  (MAXIMUM bolus = 6600 units)
		30 units/kg, Injection, IV Push, Q6H, PRN for see comment, T;N+360
			Comment: Dose = 30 units/kg Bolus. PTT level between 52-64 seconds.  Patient on Low Dose Heparin Protocol.  Pharmacy to calculate dose.  (MAXIMUM bolus = 3300 units)
Patient Care
	Notify MD
		T;N, For surgical patients, contact surgeon for approval to start heparin protocol if ordered post surgery
		T;N, if PTT is not in therapeutic range within 24 hours
		T;N, if 2 consecutive 60 unit boluses of heparin given and the resulting PTT value is not in therapeutic range within 12 hours
		T;N, For any critical PTT >135 AND with any 2 consecutive PTTs >135
		T;N, If baseline PTT is >42 seconds (5 seconds above upper normal
	Order Lab
		T;N, Enter orders for PTT Q6Hr timed after initiation of therapy or any dosage change until 2 consecutive PTT in therapeutic range, then q24h in am.
	Avoid IM Injections if possible while on anticoagulants
		T;N

*Report Legend:
DEF - This order sentence is the default for the selected order
GOAL - This component is a goal
IND - This component is an indicator
INT - This component is an intervention
IVS - This component is an IV Set
NOTE - This component is a note
Rx - This component is a prescription
SUB - This component is a sub phase