Citrate CVWH prese Ward 21:
Date_>»l Name___Soe_& DoB__»x/» fre Pt Weight (ke) _V2
Filter used _SV1000 Access (@)IJ Tene Dressing Change _____ Device number
(Fiker generally AV2000) :
Date oe) x [x
Treatment. ( Ci-Ca) Gia COMHO,
7 Calcium start rate(then APP.) 3:2 mono J 2
* Citrate start rate (then AP.P.) 0 enero |
Dialysate — K4 x 4 bags
Ork2 x2 bags if K>6.Smmoy/t | C}G KU Oratyssbe!
* Dialysate flow rate: 2260 mat fe
* Blood flow rate Mo eat Lenin
Dialysis Temp (35-39°#C) Re
Doctor's Signature D
MFT PRO SET UP Date/time/ Signature nurse 1 | Signature nurse 2
Set up by: (date/time/ 2 signatures)
Set up by: (date/time/?2 signatures)
Set up by: (date/time/2 signatures)
(tse table 1 below /*- See table 2 below / AP.P—As Per Protocol )
Ultrafiltration rate and changes — Medical prescription
Date and time mete [oe
UF rate (mis/hr} 50 mol | vt
Signature/Print
Note: Need to prescribe in Kardex (see exemplar} / See “Quick guide” for exceptions
~ CiCa Dialysate K4- rate 25mls/ka/hr (use table 1 for rough estimate. Qd:Qb 20:1 ratio)
= Sodium Citrate 4% 1500 mls- as per protocol
= Calcium Chloride 100mmol/1000mls ~ as per protocol
Calcium start rate — note: prescribe rate as adh adjust for filtrate volume)
Calcium chloride Yes Yes No No
pre-treatment bolus?
‘Starting prescription of calcium 22 20 19 is ia
|L chloride (mmol/L of filtrate)
‘Table 2— Citrate/Dialysate and blood flow rates. Based on approx. 25ml/kg/hour
Weight <60kg 60-69kg | 70-79kg | 80-89kg >90kg
Dialysate flow rate (mi/hr) 1400 1600 1800 2000 2200
Blood flow rate (mi/min} 0 80 30 | (100 30
Gitrate dose (mmol/L) 40 40. 40 40 40
Ultrafiltration rate (mi/hr) CLINICIAN DECISION ON INDIVIDUAL PATIENT BASISota _ Con
Aen-Cike COUHD VB
AS REQUIRED
THERAPY
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4S ints I Ef‘Non- Citrate CVVH prescription- Ward 215
Date_xx] x Name. whe Bogs pop__xxfy/we Pt Weight (ke)_42
Filter used Avicoo Access _) LJ Tew? Dressing Change Device number,
4 Blood Flow __ 26g mats ( Ww
om K/Blo0d Flow >250%5/he)
Exchange/hr_S0CO~d) ne Type Fluid _ wer
(xchange /he— minimum 2600mis/hr or approx B5mV/kg/hr Fuld type MultiBie 4 oF 2~
Anticoagulant (Circle) Ni (fepatin > Heparin Strength — 250iu / 10001 per ml
Pre-anticoagulation ACT Target Machine No
Prime Fluid (cireley 0.5% safe J HAS Straight connect (Y/N) ¥_ Washback removed (V/N)_Y_
Prescribed by (OR) Sign On 1 Nurse Sign on 2" Nurse
(capitals) (capitals) (capitals)
“ime | 6P [HR [AP [RP] TP ] Blood | Prejpost | Total | Fuid [ACT [Ac [AC [AC [CC | initials
Flow | Exchrate | Excha | loss rate | Bolus | level
otal
‘Crcuk Check to be completed as required but minimal hourly during treatment tick €C—2™ last column