Modes of Therapy - CRRT Explained!

Summary

In this lesson from ICU Advantage, Eddie Watson explores the different modes of Continuous Renal Replacement Therapy (CRRT), commonly used in critical care. The video details the various forms of therapy such as Slow Continuous Ultrafiltration (SCUF), Continuous Veno-Venous Hemofiltration (CVVH), Continuous Veno-Venous Hemodialysis (CVVHD), and Continuous Veno-Venous Hemodiafiltration (CVVHDF). Each mode offers unique benefits based on the treatments and needs of individual patients. Watson outlines the principles behind hemofiltration and hemodialysis, explaining how these modes operate and discussing their respective advantages in managing patient care, with a focus on fluid removal, solute clearance, and correction of acid-base imbalances.

Highlights

• Eddie Watson introduces multiple modes of CRRT and their applications in critical care. 🎓
• Clear explanations of SCUF, CVVH, CVVHD, and CVVHDF, detailing their unique operations and benefits. 🔍
• CRRT modes utilize principles of hemofiltration, hemodialysis, and sometimes a mix for optimal patient care. 🏥
• Each mode serves different purposes such as fluid removal, solute clearance, and electrolyte balance correction. ⚖️
• Eddie encourages viewers to subscribe for more insights and offers special appreciation to supporters! 👍

Key Takeaways

• CRRT offers different modes for various patient needs, including fluid overload and electrolyte imbalances. 💡
• SCUF primarily focuses on safe fluid removal without replacement fluid, while CVVH uses replacement fluids to aid solute clearance. 🚰
• CVVHD and CVVHDF integrate hemodialysis and hemofiltration principles for comprehensive waste and solute removal. 🏥
• Different modes require specific setups with dialysate and replacement fluids to achieve desired therapeutic outcomes. 🔄
• Understanding each mode's application helps make informed decisions in critical care scenarios. 🧠

Overview

In this educational video, Eddie Watson from ICU Advantage delves into the intricacies of Continuous Renal Replacement Therapy (CRRT). Designed to make complex critical care topics accessible, the video covers various CRRT modes including Slow Continuous Ultrafiltration (SCUF), Continuous Veno-Venous Hemofiltration (CVVH), Continuous Veno-Venous Hemodialysis (CVVHD), and Continuous Veno-Venous Hemodiafiltration (CVVHDF). Each of these modes is explained with clarity, emphasizing their specific roles and applications in patient treatment.

The video provides a detailed guide on setting up CRRT circuits, discussing the fundamental principles of hemofiltration and hemodialysis. Watson explains how different combinations of these principles are used in various modes, like SCUF which focuses on safe plasma removal, and CVVH which incorporates replacement fluids for enhanced solute clearance. By integrating visual aids like charts and diagrams, Watson ensures that viewers gain a comprehensive understanding of how CRRT works.

Eddie Watson's engaging teaching style not only elucidates the technical aspects of CRRT but also provides critical insights into the decision-making process for its use in clinical practice. This lesson is part of a broader series aimed at equipping healthcare professionals with the knowledge needed to perform efficient and effective patient care under critical conditions. Viewers are encouraged to subscribe for further educational content and are thanked for their continued support through memberships and Patreon.

Chapters

• 00:00 - 01:00: Introduction and Channel Overview This chapter serves as an introduction and an overview of the channel 'ICU Advantage.' Eddie Watson, the creator, welcomes both new and returning viewers to the channel. He introduces himself and mentions that the primary aim of the channel is to provide educational content. The focus is likely on intensive care unit (ICU) topics, given the channel's name.
• 01:00 - 02:00: Objective of the Video The chapter titled 'Objective of the Video' explains the goal of providing the best online critical care educational content for free. The speaker encourages viewers to subscribe to the channel and hit the bell icon for notifications to ensure they don't miss any new lessons.
• 02:00 - 03:00: Overview of Modes of CRRT This chapter provides an overview of different modes of Continuous Renal Replacement Therapy (CRRT). It builds on previous lessons about CRRT principles, emphasizing the importance of understanding these to grasp how various therapeutic approaches work and differ. The lesson is designed to be concise and informative, targeting a clear understanding of CRRT types offered, following foundational solute clearance principles discussed earlier.
• 03:00 - 04:00: Hemofiltration, Hemodialysis, and Combination This chapter discusses the different types of therapy available through Continuous Renal Replacement Therapy (CRRT), highlighting that the choice often depends on patient needs and provider preferences. The therapies consist of applications involving hemofiltration, hemodialysis, or a combination of both, expanding on concepts introduced in the previous lesson.
• 04:00 - 05:00: CRRT Circuit Explanation The 'CRRT Circuit Explanation' chapter discusses different modes of renal replacement therapies and categorizes them as hemofiltration, hemodialysis, or a combination of both. The chapter includes a visual chart for clarity. It describes the basic circuit setup, involving a patient and a dialysis line with an access line marked in red. The process includes the blood being pumped through a filter, and then exiting the filter via a return line.
• 05:00 - 06:00: Introduction to SCUF The introduction to SCUF discusses the basic components involved in the process. It explains the affluent line that comes off the filter, which is used to collect the filtrate or effluent during therapy. Regardless of the therapy mode, these basic components are always present. Variations might occur by adding, removing, or combining elements to achieve specific therapeutic principles.
• 06:00 - 08:00: CVVH Mode The chapter discusses the CVVH mode, focusing initially on slow continuous ultrafiltration (SCUF). SCUF is a fluid removal process occurring at slow rates without replacement fluid, using ultrafiltration principles. Due to the slower rates, there is minimal to no solute clearance, also known as convection.
• 08:00 - 10:00: CVVHD Mode The chapter discusses the CVVHD mode, focusing on placing this mode on a chart under hemofiltration. The main objective of this mode is the safe removal of excess fluid from patients experiencing fluid overload. The chapter explains that in setting up the CRT circuit for CVVHD, no dialysate or replacement fluid will be used. It further illustrates that the example circuit simply involves pulling blood from the patient and removing a small amount of fluid, making the process quite straightforward.
• 10:00 - 12:00: CVVHDF Mode In the chapter titled 'CVVHDF Mode', the process of continuous venovenous hemofiltration (CVVH) is discussed. This medical procedure involves both fluid removal and solute clearance. The chapter explains the principles of ultrafiltration and convection that underlie this process. It also highlights the necessity for the use of replacement fluid to compensate for the volume of fluid removed during convection, which can be administered pre, post, or in both manners to drive the convection process.
• 12:00 - 13:00: Conclusion and Next Steps The conclusion emphasizes the need for using replacement solutions in specific medical situations like uremia, serious acid-base, or electrolyte imbalances, and the requirement for removing large molecules. It also notes the absence of dialysate in this particular modality and the importance of adding this information to existing charts for better understanding and application.
• 13:00 - 14:30: Support and Engagement with the Channel The chapter discusses the setup of a hemo filtration circuit, explaining the addition of replacement fluid. There are two potential points for adding this fluid: pre-dilution (before the blood reaches the filter) or post-dilution (after the blood has passed through the filter). The chapter briefly touches on the possibility of combining both methods.

Modes of Therapy - CRRT Explained! Transcription

• 00:00 - 00:30 [Music] all right welcome back you guys to another video lesson from icu advantage if this is your first time here to the channel welcome if not welcome back and for those of you who don't know me my name is eddie watson now my whole goal in creating this channel icu advantage
• 00:30 - 01:00 was really to try and provide some of the best online critical care educational content that's out there and make it free and really freely available for you guys to watch i really hope that i'm able to do just that for you guys and really if you'd be interested in getting more of this critical care educational content then i do invite you to subscribe to the channel down below if you do make sure you hit that bell icon and select all notifications that way you'll never miss out whenever i release a new lesson all right so in this next lesson this is going to be the fourth lesson in this
• 01:00 - 01:30 series on crt explained and in this lesson we're going to be discussing the different modes or types of therapy that we can offer with crt this should be a relatively short lesson now in the last lesson in the series we talked about the principles of crt that really guide our therapy and our solute clearance if you haven't watched that already please watch that lesson first as understanding those basic principles is really going to help you to understand how these types of therapy really work and differ from one another
• 01:30 - 02:00 there are several different types of therapy that we can offer with crt and much of it's going to depend on what the patient needs as well as really the provider preference on how they want to run it and so let's go ahead and get into talking about these different modes that we have and it's important to know that the therapy that we can offer people really consists of various applications of either hemofiltration hemodialysis or a combination of both principles which were discussed in great detail in that last lesson
• 02:00 - 02:30 so as we talk about these different modes i'm going to add them to this chart here so you can really see where they fall in this alignment of either hemofiltration or hemodialysis or some combination of both now as well as when we go through and talk about these different modes i have the basic circuit set up here with a patient and again as you remember from that second lesson we have our dialysis line with our access line coming off in red the blood is going through our blood pump pushing it through the filter and then from there we have the blood exiting the filter via the return
• 02:30 - 03:00 line and going back to the patient now in addition to that we also have our affluent line coming off of the filter and this is to collect the filtrate or effluent that we pull off in therapy so regardless of the different mode that we're going to talk about all of them are going to have these basic components to them and then from there we're going to either add or take away or do some different combination of other things in order to achieve the different principles that we talked about from that last lesson so as i go through and talk about those i'm going
• 03:00 - 03:30 to include those on here so you can really see how that fits into our crt circuit so the first of these modes that we're going to talk about here is going to be our slow continuous ultrafiltration or scuff now essentially this is the process of removing fluid so ultra filtrate or affluent at slow rates and without using any replacement fluid now this mode uses the principle of ultrafiltration but because of the slow rate of it we have little to no solute clearance aka convection and so
• 03:30 - 04:00 let's go ahead and place this one on our chart here under the hemo filtration and the main goal of scuff is going to be the safe removal fluid from the patient who has fluid overload now when we talk about the setup of our crt circuit we're not going to be using any dialysate nor replacement fluid so essentially the circuit that i have shown here as an example is exactly what we're going to have we're just going to pull blood from the patient and we're going to pull a small amount of fluid off as a fluid so pretty straightforward all right so
• 04:00 - 04:30 the next mode that we're going to talk about is going to be our continuous vino vino hemofiltration or cvvh and so here we're going to have the process of both fluid removal as well as solute clearance the principles that we're going to be using here are both ultra filtration and convection and so now because of the volume of fluid that's going to be removed in order to drive that convection we must use replacement fluid and this can be either pre post or both now again this is going to
• 04:30 - 05:00 remove both the small and large molecules and we will see that the ph will be impacted by the buffer that's being contained in our replacement solution now this therapy is going to be indicated in uremia and severe acid-base or electrolyte disorders or if the removal of large molecules is needed and for this mode we're not going to have any dialysate that's used but we are going to be using replacement fluid so let's go ahead and add this mode to our chart that we have here and again this one's going to be listed
• 05:00 - 05:30 under our hemo filtration side and then if we look at our circuit setup here we're still going to have the same setup that we have drawn out here in addition to that we're going to be adding in some sort of replacement fluid and there's two different spots that we can be adding this fluid we can either be adding it pre-dilution so essentially into the blood before it gets to the filter or we can be adding it post dilution to the blood after it's gone through the filter or like i said some combination of the both all right so let's go ahead and move on and we'll talk about the next mode that
• 05:30 - 06:00 we have here the continuous vino veno hemodialysis or cvvhd now this is going to be the process of removing waste products and solutes and for this mode we're going to be using the principle of diffusion also known as hemodialysis and so let's go ahead and add that one into the chart here under the hemodialysis column and so here in this mode we're only going to be removing the small and medium-sized waste products and solutes as well as our patient's ph is going to be impacted by the buffer that's
• 06:00 - 06:30 contained in the solution that we use now we can also use this mode to safely remove fluid volume from the patient so here though we're going to primarily be using this for patients with uremia and either severe acid base or electrolyte imbalances and for this setup here we're going to be using dialysate but not replacement fluid so here we're going to have our dialysate solution which we're going to infuse into the filter on the outside of those hollow fiber semi-permeable membrane tubes that are carrying the blood and then that dialysate is going to come
• 06:30 - 07:00 out of the filter in the form of the effluent so you can think here because we have this dialysate fluid flowing through the filter on the outside of that semi-permeable membrane we're creating that concentration gradient thus giving us the diffusion or the hemodialysis which makes up its name all right and so moving on we'll talk about the last moda therapy that we have something that we call continuous vino vino hemodyala filtration or cbvhdf so here again this is going to be the process using a combination of principles to
• 07:00 - 07:30 remove waste products solutes as well as fluid and so here the principles that we're going to be using are going to be diffusion ultrafiltration as well as convection now one thing i didn't specifically mention in any of these modes here is the principle of adsorption and that is actually going to be present for all of the modes that we do again really just kind of dependent on the filter type that you're using if it has more adsorptive properties then we're going to see those benefits in the
• 07:30 - 08:00 therapy so now let's go ahead and add this mode to our chart here and as you can see this one actually uses both hemo filtration as well as hemodialysis so we're going to have this one straddling the middle of our chart now in my experience though most patients are typically just ran on this type of therapy part of the reason is because it's going to be the most efficient and can contribute both to removing fluid controlling our patient's fluid balance as well as that waste and solute clearance but in addition to that if we want to change modes for our
• 08:00 - 08:30 patient you can't on some machines add the therapy as you go you'd have to stop take down the filter and reset it up with the new therapy that you want to do as opposed to if you have the patient running in cvvhdf you can just turn down the flows to either replacement or dialysate which would essentially be doing the same thing so speaking of that this therapy is going to require both the use of dialysate and replacement fluid and this therapy is going to be effective at clearing small medium
• 08:30 - 09:00 and large size molecules our patient's ph is going to be impacted by the buffer and the solutions and we can safely remove fluid from our patients in this mode and our indications to use this one here is going to be for uremia severe acid base and electrolyte imbalances fluid removal or when large molecule clearance is necessary so again looking back at our circuit setup we're going to have the use of both the dialysate as well as the replacement solution and again we'll have our dialysate going in top to bottom in the filter and
• 09:00 - 09:30 coming out as a fluent and then we'll have our replacement solution either going in pre-dilution into the blood before the filter or running as post dilution going into the blood after the filter and so in this mode we're going to be using all of the different parts and all of the different fluids that we talked about in that second lesson as we went through the full setup of the crt circuit so again cvvhdf is going to be our most inclusive it's going to be hitting both the hemofiltration and the hemodialysis and really providing the most amount of
• 09:30 - 10:00 clearance and support for our patients all right so i hope this lesson really kind of clearly explained the differences between the different modes that we have for crt and really also to help you kind of understand which basic principles of crt are being used for each mode and really how that's benefiting our patient so we've really kind of stepped our way through these first few lessons and kind of talked about you know things that built upon one another to get us to the point to where when we talk about these different modes
• 10:00 - 10:30 that you'd have a good understanding of what's happening in each one there are going to be a few more lessons after this one which are going to cover different aspects of crt therapy which are going to be certainly beneficial if you're taking care of these patients so make sure you guys stay tuned in order to catch those future lessons otherwise though i really hope that you guys enjoyed this lesson i really hope that i was able to explain this stuff out in a good way for you guys here if you liked it please leave a like down below again it really goes a long way to help support this channel as well as leave me a comment let me
• 10:30 - 11:00 know what you thought if you have any questions i always enjoy reading your comments and responding back to you guys as well as make sure and subscribe to the channel if you haven't already a special shout out to our awesome youtube members and patreon members out there the support that you guys offer really goes a long way in helping to allow me to do and improve this channel so for that i'm really appreciative and i want to thank you guys if you'd be interested in showing additional support for this channel uh head down below either join the youtube channel membership or head over to patreon to check out some of the additional perks that you get for doing
• 11:00 - 11:30 just that like i said make sure and stay tuned for the next lesson otherwise in the meantime though make sure and check out a couple really awesome videos i'm going to link to right here as always thank you guys so much for watching have a great day