Unique Plan Description: Nephro CRRT Citrate and Calcium
Plan Selection Display: Nephro CRRT Citrate and Calcium
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: 2024-03-18 11:45:00
Available at all facilities: Yes

Nephro CRRT Citrate and Calcium
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 2-0 - WHITE scale
		5,000 mL, Dialysis, ml/hr
			Comment: Pre-filter White scale, PrismaSOL 2/0. Contains potassium 2 mEq/L, calcium 0 mEq/L. RN to activate solution prior to administration.
	PrismaSOL BGK 3-0 - WHITE scale
		5,000 mL, Dialysis, ml/hr
			Comment: Pre-filter White scale, FINAL SOLUTION = PrismaSOL 3/0. Contains potassium 3 mEq/L, calcium 0 mEq/L. Pharmacy to activate solution upon dispensing.
		5 mEq, EVERY BAG
	PrismaSOL BGK 4-0 - WHITE scale
		5,000 mL, Dialysis, ml/hr
			Comment: Pre-filter White scale, FINAL SOLUTION = PrismaSOL 4/0. Contains potassium 4 mEq/L, calcium 0 mEq/L. Pharmacy to activate solution upon dispensing.
		10 mEq, EVERY BAG
	PrismaSOL BGK 5-0 - WHITE scale
		5,000 mL, Dialysis, ml/hr
			Comment: Pre-filter White scale, FINAL SOLUTION = PrismaSOL 5/0. Contains potassium 5 mEq/L, calcium 0 mEq/L. Pharmacy to activate solution upon dispensing.
		15 mEq, EVERY BAG
		Dialysate - Green Scale(NOTE)*
	PrismaSATE BGK 2-0 - GREEN scale
		5,000 mL, Dialysis, ml/hr
			Comment:  Dialysate Green scale, PrismaSATE 2/0, Contains potassium 2 mEq/L, calcium 0 mEq/L. RN to activate solution prior to administration.
	PrismaSATE BGK 3-0 - GREEN scale
		5,000 mL, Dialysis, ml/hr
			Comment: Dialysate Green scale, FINAL SOLUTION = PrismaSATE 3/0. Contains potassium 3 mEq/L, calcium 0 mEq/L. Pharmacy to activate solution upon dispensing.
		5 mEq, EVERY BAG
	PrismaSATE BGK 4-0 - GREEN scale
		5,000 mL, Dialysis, ml/hr
			Comment: Dialysate Green scale, FINAL SOLUTION = PrismaSATE 4/0. Contains potassium 4 mEq/L, calcium 0 mEq/L. Pharmacy to activate solution upon dispensing.
		10 mEq, EVERY BAG
	PrismaSATE BGK 5-0 - GREEN scale
		5,000 mL, Dialysis, ml/hr
			Comment: Dialysate Green scale, FINAL SOLUTION = PrismaSATE 5/0. Contains potassium 5 mEq/L, calcium 0 mEq/L. Pharmacy to activate solution upon dispensing.
		15 mEq, EVERY BAG
		Post-Filter Replacement-Purple Scale(NOTE)*
	PrismaSOL BGK 2-0 - PURPLE scale
		5,000 mL, Dialysis, ml/hr
			Comment: Post-filter Purple scale, PrismaSOL 2/0. Contains potassium 2 mEq/L, calcium 0 mEq/L. RN to activate solution prior to administration.
	PrismaSOL BGK 3-0 - PURPLE scale
		5,000 mL, Dialysis, ml/hr
			Comment: Post-filter Purple scale, FINAL SOLUTION = PrismaSOL 3/0. Contains potassium 3 mEq/L, calcium 0 mEq/L. Pharmacy to activate solution upon dispensing.
		5 mEq, EVERY BAG
	PrismaSOL BGK 4-0 - PURPLE scale
		5,000 mL, Dialysis, ml/hr
			Comment: Post-filter Purple scale, FINAL SOLUTION = PrismaSOL 4/0. Contains potassium 4 mEq/L, calcium 0 mEq/L. Pharmacy to activate solution upon dispensing.
		10 mEq, EVERY BAG
	PrismaSOL BGK 5-0 - PURPLE scale
		5,000 mL, Dialysis, ml/hr
			Comment: Post-filter Purple scale, FINAL SOLUTION = PrismaSOL 5/0. Contains potassium 5 mEq/L, calcium 0 mEq/L. Pharmacy to activate solution upon dispensing.
		15 mEq, EVERY BAG
	Sodium Bicarbonate 75 mEq/NS 0.45% 1000 mL - PURPLE scale
		1,000 mL, Dialysis, ml/hr
			Comment: Post-filter Purple scale
		75 mEq, EVERY BAG
	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
	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
	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

Calcium Citrate Anticoagulation Protocol
Laboratory
	Post Filter Ionized Calcium
		T;N, Q6H, Timed, spec type = CRRT Filter Blood
	Ionized Calcium
		T;N, Timed, Q6H, spec type = Blood
IV Solutions
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	anticoagulant citrate dextrose - CRRT
		1,000 mL, Dialysis, 150 ml/hr
			Comment: Titrate based on post-filter ionized calcium.Post-filter ionized Ca < 0.25 mmol/L = decrease rate by 10mL/hr.Post-filter ionized Ca 0.25-0.35 mmol/L (goal range) = No change.Post-filter ionized Ca 0.36-0.45mmol/L = Increase rate by 10mL/hr.Post-filter ionized Ca >0.45 mmol/L = Increase rate by 20mL/hr.If anticoagulant citrate dextrose infusion is interrupted, please clarify with provider regarding restarting infusion and rate of infusion. If CRRT stopped for any reason, stop anticoagulant citrate infusion and clarify with provider regarding restarting infusion and rate of infusion.
	Calcium Chloride 6gm/1000mL D5W
		6,000 mg, EVERY BAG
		1,000 mL, IV, 60 ml/hr
			Comment: Titrate based on Systemic ionized calcium (mmol/L).Systemic ionized Ca > 1.3 mmol/L = decrease rate by 10mL/hr.Systemic ionized Ca 1.1-1.3 mmol/L (goal range) = No change.Systemic ionized Ca 0.9-1.1 mmol/L = Increase rate by 10mL/hr.Systemic ionized Ca < 0.9 mmol/L = Increase rate by 20mL/hr.If calcium chloride infusion is interrupted, please clarify with provider regarding restarting infusion and rate of infusion. If CRRT stopped for any reason, stop calcium chloride infusion and clarify with provider regarding restarting infusion and rate of infusion.

*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