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Ordering hemodialysis for pediatric patients cheat sheet
Typology: Cheat Sheet
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Ordering HD treatments Cheat sheet Step 1: Dry weight: BSA: Step 2: Dry wt kg X 80 = estimated circulatory BV Circulatory BV x 0.1 (10%)= max extracorporeal BV Step 3: select dialyzer Dialyzer BSA Prime Volume Kuf/ufr ml/min 200 ml/min F3 0.4 28 1.7 125 F4 0.7 42 2.8 155 Elisio 9 H 0.9 60 53 190 Elisio 11 H 1.1 69 59 193 Elisio15 H 1.5 93 67 198 Elisio19 H 1.9 115 76 199 Elisio 25H 2.5 148 93 200 Step 4 select tubing Age Tubing Prime Volume neonatal Fresenius 2mm 29 infant Fresenius 2.6 24 Age 1-4 approx Fresenius 4.8 48 pediatric Fresenius 6mm 73 adult Fresenius 8mm 109 **** dialyzer prime plus tubing prime should not be greater than 10% of circulating blood volume Dialyzer ml + tubing ml = System total ml If system total is > max extracorporeal blood volume, volume expander albumin or PRBC prime or smaller circuit Step 5 Calculate BF Clearance 1 st**^ tx 1.5/2 ml/min 2 nd^ tx 3 ml/min 3 rd^ tx 4 ml/min chronic 5 - 8 ml/min Dry weight x clearance (in chart above) Example: Dry wt: 30kg (BSA 1.2) So… 30x 2ml (Clearance first tx) =
Pick filter based on BSA. (1.2) Answer: Elisio 11H. ( closest specs at BSA= 1.1) Elisio 11 H Manufacturer specs: 200 ml/min= 193 Figure the BF by multiplying 60 (clearance 1st^ tx) × 200 (200ml/min) then divide the answer by 193 (specs for filter @200 ml/min) (200x60=12000) divide 12000 by 193= 62.17 round to nearest increments of 5 BFR= 60 Step 6 Dialysis flow: Standard is two times blood flow rate Conventional HD ranges 300 to 800. Younger patients use flows of 100,150, and 200/min on “low flow” mode. Step 7 Priming solution: a. NS: ECV under 10% and hemodynamically stable b. Albumin: ECV is at or near 10% or comorbidities c. PRBC: ECV is OVER 10% or concurrent comorbidities (consider if returning blood prime to patient could potentially cause circulatory overload an infant). Step 8: Electrolyte concentration: a. Bicarb 35 to 40 if CO2 low or at 22-choose higher b. K 1,2,or 3. meq/L ( standard is 2). K can take 2 hrs to equilibrate after tx c. Calcium 2.5, 3, and 3.5 (Standard is 3) d. Sodium 130 - 155 Standard is 140 e. **Step 9: UF/and hourly rate- *** pt UO, adjust UF, so don’t decrease UO. Do not remove more than 5% of patient’s body weight for one treatment. May need to consider sequential treatment if necessary. Max of two hours DUF due to hyperthermia risk. Hourly UF rate should not exceed 13ml/kg/hr Step 10: Anticoagulation type: Heparin bolus: 10 to 30 units per kilogram (normal 20u/kg) MAX 50u/kg Heparin maintenance rate: 10 - 20 u/kg/hr (normal 10u/kg) Heparin free: q15 - 30 min NS bolus 2.2mm-50ml; 4.8mm-75ml; 6.4mm-100ml, 8mm-200ml Step 11 Blood pressure parameters (see AAP BP guidelines) Step12 Fluid Resuscitation: less 10kg-25 ml increments, 10-20kg-50ml, 20-60kg- 100ml, greater 60- 200ml Step 13 Heparin packing: Standard packing is 1000u/ml. No overfill. Fill volume is catheter hub volume without overfill. (tPA, ABT locks, or ClearGuard caps if needed)