Slow continuous therapy
1. Á¾·ù
¨ç slow continuous hemodialysis: CVV-HD, CAV-HD
¨è slow continuous hemofiltration: CVV-H, CVV-H
¨é slow continous ultrafiltration: CVV-U, CAV-U
2. Slow continous hemodialysis(CVV-HD, CAV-HD)
1) rationale
i) hemodynamically well tolerated: minimal change in plasma osmolality
ii) better control of azotemia & electrolyte & acid-base balance
iii) highly effective in removing fluid
iv) parenteral nutritionÅõ¿© ¹× IV medication¿¡ ¿ëÀÌÇÏ´Ù.
2) VV access
subclavian -> subclavian(Áß°£¿¡ hemodialyzer, roller pump)
3) AV access
femoral artery -> femoral vein
* venovenous°¡ arteriovenous accessº¸´Ù ÀåÁ¡
: hematoma¸¦ ÇÇÇÒ¼ö ÀÖ´Ù.
roller pump°¡ ºü¸£´Ù.
±× °á°ú dialyzer performance°¡ Áõ°¡µÇ°í º¸´Ù Áß¿äÇÑ °ÍÀº Ç÷¾×ÀÇ Á¤Ã¼·Î ÀÎÇÑ clottingÀ»
°¨¼Ò½ÃŲ´Ù.
cf. ´ÜÁ¡
Áö¼ÓÀûÀÎ pumpÀÛ¿ëÀ¸·Î ÀÎÇÏ¿© line disconnection or air leakage°¡´É¼ºÀÌ ÀÖ´Ù.
5ÀÏÀÌ»ó catheterÁö¼Ó½Ã exit-site, catheter-induced bacteremia, subclavian vein
thrombosis & stenosisÀ§ÇèÀÌ Áõ°¡ÇÑ´Ù.
4) dialysis solution inflow rateÀÇ °áÁ¤
10 L/dayºÎÅÍ 30 L/dayÀÌ»ó±îÁö °¡´ÉÇÏ´Ù.
residual renal functionÀÌ ¾øÀ» ¶§, hypercatabolic state¿¡¼± ´õ ³ôÀÏ Çʿ䰡 ÀÖ´Ù.
BUN»ý¼º¼Óµµ¸¦ Æò°¡ÇÏ¿© °áÁ¤Çϴµ¥ ICUȯÀÚ´Â º¸Åë 5 - 20 g/dayÀÇ BUNÀÌ »ý»êµÈ´Ù.
(BUN»ý¼º °ø½ÄÀº handbook¿¡ ¿¹Á¦ ³ª¿ÍÀÖÀ½)
5) Àåºñ: pumps
¨ç CVV-HD
48 L/day(2000 ml/hour = 33.3 ml/min)·Î ultrafiltration rate¸¦ settingÇÑ´Ù.
¨è CAV-HD
800 ml/hr(=13.3 ml/min)·Î settingÇÑ´Ù.
3. slow continous hemofiltration(CVV-H, CAV-H)
1) rationale
continous hemodialysis¿Í µ¿ÀÏÇÏ´Ù.
purely convection-based blood cleansing techniqueÀ» ÀÌ¿ëÇÑ´Ù´Â Â÷ÀÌ.
2) solute removal
continous hemofiltrationÀ¸·ÎÀÇ plasma urea clearance´Â continous hemodialysisº¸´Ù
Æò±Õ 50% Àû´Ù.
3) blood access & circuitry
CAV-H´Â CAV-HD¿Í µ¿ÀÏÇϰí CVV-H´Â CVV-HD¿Í µ¿ÀÏÇÏ´Ù.
* CAV-H
femoral artery -> hemofilter -> femoral vein
(heparin) (replacement solution)
4) CAV-HÀÇ GFR: ´ë·« 10L/day = 7 ml/min
4. slow continuous ultrafiltration(CVV-U, CAV-U)