I never post comments but I will in this case. You have done/continue to do such an extraordinary job in simplifying these ICU concepts. As an ICU nurse for 6 years, I enjoy watching your videos for review, clarification, and simply learning new material. Please continue making these fantastic videos! You are helping thousands, if not millions, of healthcare practitioners out there in the world. You are making a big difference. Keep it up!
Wow, Ken, thank you so much for taking the time to leave a such a great comment. I really appreciate the kind words and its great to know they are appreciated by so many. Thats truly my goal is to help others with these topics so it's great to hear the feedback. Thank you! I will certainly continue to keep making them!
I am an ICU nurse who has used CRRT for a little over a year now. Your explanations have been amazing. When trouble shooting the machine the corrections I make definitely make more sense now.
Fantastic to hear! I've always been of the belief that the more you understand the why behind what you are doing, the more it makes sense and the easier it is to remember and then think of what to do when you need to. Glad you liked it!
Going to CKRT class today and they gave us a module to study but it is overwhelming. Decided to search in youtube to clarify it and found this gem. Watching all your CRRT videos right now before my class this week to clarify it. Thank you so much!
Yeah I could imagine that just giving stuff to study without any guidance would be difficult. Glad you found the video helpful. I really like the CRRT series. I think this one came out really good so I hope you enjoy it!
Really appreciate it.. it is very comprehensive n very methodical. The way you explained CRRT with the physiology is very much impressive. I loved it!!! Wish you all the successs.. And big thank you...
Thank u so much ......I read this in books but it's not make me to concentrate ....but your explanation make me easy to understand without any distraction ....I am final yr student in renal dialysis technologist (AHS) .....😔😞here my seniors are not teaching me but always want to insult me without thought me anything .....🤗but now I understand the concepts ....thank u
I really appreciate all the education and review. Thank u again for granting my request for crrt. One that I have been trying to get a class on is the impella. Very rare they were able to get that class at work, and the moment they had it, covid came along, so the class had to be canceled. I would highly appreciate it if you could do a lesson on that. Thank u in advance!
My pleasure. CRRT has been something that people have been asking for a while and I've been wanting to do it. I do have Impellas and temp LVADs on my todo list for the future!
@@ICUAdvantage oh thank u! I've been a critical care nurse for a long time and it still fascinates me. I love to learn more and review, but I hate reading. Ur videos help me a lot! Impella patients are the only ones I really haven't taken cared of in in our unit.
I have binged so many of your videos on here. They are very helpful/interesting even for a seasoned nurse. I am definitely telling all my new grads and orientees about your channel. Is there a video in the works for SLED?? Thanks again!!!
Awesome! Glad you are liking them Heather and thank you so much for spreading the word! 😊 I don't currently have plans for SLED, but I'll add it to the ever growing todo list.
As always, my pleasure. Glad to hear that I was able to explain everything clearly. I certainly try my best, but sometimes I can never tell if it only makes sense because I know what I'm trying to say. 😂
Hi Eddie, I am/was a children's nurse, based in The Netherlands. Started my adult ICU course after helping out lots on the ICU during the pandemic. I have a few more months to go, but almost finished :D Your videos are fantastic! They have helped me so much to make sense of different principles and machines which we come across on the ICU. I've got my last exam on monday which is all about the renal system and CRRT. Fingers crossed, your videos will have helped me once again to pull it off!
Glad to hear you liked the series! Great question. I think in one of the lessons I mentioned about some examples but basically: Small: Mostly our electrolytes, as well as urea. Medium: Creatinine (borders on small), Uric acid, Glucose Large: Inflammatory mediators/cytokines, Insuline, B2 Microglobulin, Myoglobin. CRRT, depending on filter, should clear molecules up to about 50,000 daltons, which keeps Albumin just out of range for clearance.
Hi! I don’t understand this one thing, could you please explain to me? From second video I understood that you need Dialysate for both Hemofiltration and H-D. But here I see that we don’t use one in hemofitration? As I understood, you need to have a pressure gradient to do hemofiltration, But how do you do that if you don’t have a second fluid? 🤷♀️
how do we decide in what phase to use the replacement fluid? like when do we decide to use it as a pre-dilution and when do we use it as a post-dilution and when and WHY do we use both?
So really the nephrologist makes this call, but I've almost always seen it 50/50 using both. They each have benefits and draw backs and the 50/50 split I think gives us a good cost/benefit for each.
Thank you very much Eddie for your videos, they are very explanatory. I have a question, in my hospital we still use SLEDD, where does that mode belong to?
Hello we use NxStage CRRT machine , pls explain how to set it up for CVVH mode , and confuse about dialysate, so we don’t run the dialysate solution Thanks
I don't have much experience with NxStage but my understanding is there is just one bag of fluid that is used to feed each part, but that you still have fluid either pre or post and it is also the fluid that is used on the outside of the filter. The fluid that is outside the filter is considered the dialysate.
Dear it's same like CVVH but it's working through two in one function means we use replacement Fliud both side pre and post dilution that why it's kit is also separate
Hi Eddie, by not using the dialysate in CVVH mode, there will be no diffusion to remove solutes, so the solutes are removed only by convection? If that is the case, will CVVH has less effectiveness in clearing the solutes when comparing to CVVHDF mode? Thanks
Thank you for the videos. I still struggle to fully understand CVVHDF prescription. If the ‘dialysis dose’ is the total effluent ( that’s ultrafiltration plus the dialysate), we would prescribe 30ml/kg/h for a 70kg patient, that’s 2100ml/h. In a unit I worked in they do 50%dialysate (1050ml/h) and 50% replacement (1050ml/h) but they don’t have to be 50/50, right? Is that just convention? If I take no fluid off, the effluent will be 2100ml/h, correct? If I want to run a negative balance of - 100ml/h, does the machine then replace 100ml/h less or does it pull off 100ml/h more?
Great questions. Do you not run a pre-replacement fluid? Typically the dialysate will run at a much faster rate, and then the pre & post are commonly matched. Don't have to be though. So a typical run rate will be something like 500 pre, 1000 dialysate, 500 post. The actual numbers certainly vary, but as a general idea. To your question, your effluent, with running the patient even, will be roughly equal to the total volume of all your solutions. Its not exact, but close. This is why we monitor these discrepancies and adjust hourly for them. If you are running the patient negative, the machine is using variable pressure to create more or less hydrostatic pressure to pull (or really push) more fluid out. It modulates these pressures to ensure the proper fluid removed. Again, not exact, but recorded and adjusted hourly.
Great question. The difference between CVVHD and CVVHDF is adding hemofiltration (ultrafiltration) to hemodialysis. Think convection here. We drive convection by using the pre or post dilution fluid, which the machine has to pull off that same volume from the blood, creating the large flow of volume and thus the convection with it. If we turned the flow of the pre and post dilution (PBP and Post Filter Replacement if using the Baxter machines) we would remove the convection, leaving us with just the hemodialysis. Hope that makes sense. 🙂
Quick qestion I was wondering about.What happens if i run the machine with the dialysate on zero and the ultrafiltration or fluid removal on zero?what does the filter remove in that case?since i don`t use dialysate it`s not removing ions,it won`t remove fluids either cause I deactivated it. But will it remove ureea and creatinine?
If I'm understanding what you are asking, if you had no diffusion nor ultrafiltration (and thus no convection) you wouldn't have anything. You would essentially be just running blood through the filter, and I guess maybe having some adsorption happening.
@@ICUAdvantage well on the prismaflex you have the option in cvvhdf to turn off the dialysate by putting it to 0 flow.You also have the option to set the fluid removal to zero.So practically you remain with post and/or predilution.Will the filter remove anything?or it would just run with zero effect?cause i tried it and the efluent bag was still filling up.
@@PREDATOR0140 I see what you are asking now. Ok, so you still have convection taking place with pre/post fluid running as that still needs to be pulled back off, hence the effluent collection. You will still have solute clearance. Pt fluid removal is just about balance for the patient. If you have pre & post both at 500ml/hr, and pt fluid removal set to zero, you'll have 1000ml/hr of effluent collection, driving convection.
@@ICUAdvantage when we talk about solute clearence you mean than BUN and creatinin will still be cleared right?what about the electrolites?since there is no diffusion taking place they will be unchanged if i understand it correctly.
Hi! thanks a lot for the amazing sereies. I have a tiny question. How CVVHD may be used for removing fluid? If I understand properly - in that specific mode, we use only diffusion and that help us remove electrolytes but not fluid (there is no hydrostatic pressure or osmosis).
I never post comments but I will in this case. You have done/continue to do such an extraordinary job in simplifying these ICU concepts. As an ICU nurse for 6 years, I enjoy watching your videos for review, clarification, and simply learning new material. Please continue making these fantastic videos! You are helping thousands, if not millions, of healthcare practitioners out there in the world. You are making a big difference. Keep it up!
Wow, Ken, thank you so much for taking the time to leave a such a great comment. I really appreciate the kind words and its great to know they are appreciated by so many. Thats truly my goal is to help others with these topics so it's great to hear the feedback. Thank you! I will certainly continue to keep making them!
@@ICUAdvantage No problem! I know you made a vid on TEG, would you be able to make one on ROTEM please?
I just could NOT understand renal replacement until I watched this video. Thank you for your help and please continue to make these videos!!!
Awesome! really happy to hear this and truly happy to be able to help!
I’m a. Anesthesia resident. And You have save me . Keep uploading videos please
Awesome! Happy to be able to help. I will certainly keep making more videos.
I am an ICU nurse who has used CRRT for a little over a year now. Your explanations have been amazing. When trouble shooting the machine the corrections I make definitely make more sense now.
Fantastic to hear! I've always been of the belief that the more you understand the why behind what you are doing, the more it makes sense and the easier it is to remember and then think of what to do when you need to. Glad you liked it!
Thanks
Thank you so much for this!
You deserve it
Going to CKRT class today and they gave us a module to study but it is overwhelming. Decided to search in youtube to clarify it and found this gem. Watching all your CRRT videos right now before my class this week to clarify it. Thank you so much!
Yeah I could imagine that just giving stuff to study without any guidance would be difficult. Glad you found the video helpful. I really like the CRRT series. I think this one came out really good so I hope you enjoy it!
Thanks!
Thank you so much Amish!
Really appreciate it.. it is very comprehensive n very methodical. The way you explained CRRT with the physiology is very much impressive. I loved it!!! Wish you all the successs.. And big thank you...
Thank you so much for posting this, really helped me understand the different modes of CRRT!
Perfect! Glad this video was able to help.
This video is very useful for nurses just rotated to ICU !! really appreciated.
..and doctors too! Hello from a Tasmania Doc. Thanks for these great vids. They keep getting recommended by one of our ICU consultants (Attendings)
Thank u so much ......I read this in books but it's not make me to concentrate ....but your explanation make me easy to understand without any distraction ....I am final yr student in renal dialysis technologist (AHS) .....😔😞here my seniors are not teaching me but always want to insult me without thought me anything .....🤗but now I understand the concepts ....thank u
Thank you! It has been a while since I done CRRT. The lecture was a good refresher.
Glad you hear it was a good catchup for you Miko! Thank you!
The series is amazing u r just a life saver
Happy to hear this Taqua!
Excellent, thank you so much for all of these videos!
Glad you like them!
This whole series is amazing! fantastic learning. Thanks so much
So great to hear this Claire! Really glad you enjoyed the series!
Thankyou so much for this, I've spent days trying to get my head round this and it's just clicked!
Yes!!! Happy to hear this!
Very amazing serie! Thank you. Hope to nail my exam next week about CRRT!
THANKS A LOT 🙏
Hope the exam went well!
Very very wonderfully explained 👏 👌 thank you 🙌
Amazing.. Thanks so much . Big like from Saudi Arabia.
Thank you and hello in Saudi Arabia! How cool!
So glad I found this.. excellent explanations and diagrams. I start nursing school in august and work in the cvicu as a tech, so it’s Uber relevant
Congrats on starting nursing school. And yes, def super relevant for CVICU for sure. Best of luck to you!
Excellent explanation! I understood it perfectly! ❤
Very well explained and easy to understand! Thank you so making the video !
Glad it was helpful!
thank you alot for this nice explanation
I really appreciate all the education and review. Thank u again for granting my request for crrt. One that I have been trying to get a class on is the impella. Very rare they were able to get that class at work, and the moment they had it, covid came along, so the class had to be canceled. I would highly appreciate it if you could do a lesson on that. Thank u in advance!
My pleasure. CRRT has been something that people have been asking for a while and I've been wanting to do it. I do have Impellas and temp LVADs on my todo list for the future!
@@ICUAdvantage oh thank u! I've been a critical care nurse for a long time and it still fascinates me. I love to learn more and review, but I hate reading. Ur videos help me a lot! Impella patients are the only ones I really haven't taken cared of in in our unit.
I have binged so many of your videos on here. They are very helpful/interesting even for a seasoned nurse. I am definitely telling all my new grads and orientees about your channel. Is there a video in the works for SLED?? Thanks again!!!
Awesome! Glad you are liking them Heather and thank you so much for spreading the word! 😊
I don't currently have plans for SLED, but I'll add it to the ever growing todo list.
Thank you once again Ed. Very simple yet informative presentation as always. God bless.
As always, my pleasure. Glad to hear that I was able to explain everything clearly. I certainly try my best, but sometimes I can never tell if it only makes sense because I know what I'm trying to say. 😂
Thanks Ed! Awesome work!
Great video Eddie, love the organization in your videos. Makes it so much easier to follow
Thank you Danny. I really try to organize things so that they make sense together and I'm really glad to hear it is well received.
amazing and concise !
Glad you think so!
Hi Eddie,
I am/was a children's nurse, based in The Netherlands. Started my adult ICU course after helping out lots on the ICU during the pandemic. I have a few more months to go, but almost finished :D Your videos are fantastic! They have helped me so much to make sense of different principles and machines which we come across on the ICU. I've got my last exam on monday which is all about the renal system and CRRT. Fingers crossed, your videos will have helped me once again to pull it off!
Hi Eddie,
Thanks - this series has been amazing! Can you please give examples for the small/medium/ large solutes you keep referring to? Thanks!
Glad to hear you liked the series! Great question. I think in one of the lessons I mentioned about some examples but basically:
Small: Mostly our electrolytes, as well as urea.
Medium: Creatinine (borders on small), Uric acid, Glucose
Large: Inflammatory mediators/cytokines, Insuline, B2 Microglobulin, Myoglobin.
CRRT, depending on filter, should clear molecules up to about 50,000 daltons, which keeps Albumin just out of range for clearance.
Can you give me a source on this please?
Nicely presented. Thank you
Glad to hear you liked it!
Thank you for this great lessons. Please what does standard volume and high volume filtration settings mean?
Not sure I understand your question
Bless you 👍🏽 Your videos are really helpful and supportive especially for new ICU nurse, like myself 😅
Awesome to hear this Alreem! So glad that they are helpful and you enjoy them.
Amazing videos, Eddie. Thank you so much.
Thank you Andrew! Really appreciate this and glad you liked it!
Hi! I don’t understand this one thing, could you please explain to me?
From second video I understood that you need Dialysate for both Hemofiltration and H-D. But here I see that we don’t use one in hemofitration? As I understood, you need to have a pressure gradient to do hemofiltration, But how do you do that if you don’t have a second fluid? 🤷♀️
Can you also explain how SLEDD works please. Love your channel.
Thank you and it is on the todo list!
how do we decide in what phase to use the replacement fluid? like when do we decide to use it as a pre-dilution and when do we use it as a post-dilution and when and WHY do we use both?
So really the nephrologist makes this call, but I've almost always seen it 50/50 using both. They each have benefits and draw backs and the 50/50 split I think gives us a good cost/benefit for each.
Thank you very much Eddie for your videos, they are very explanatory. I have a question, in my hospital we still use SLEDD, where does that mode belong to?
Really glad to hear this. SLED is not a mode of CRRT. Its a slow run HD essentially.
Hello we use NxStage CRRT machine , pls explain how to set it up for CVVH mode , and confuse about dialysate, so we don’t run the dialysate solution
Thanks
I don't have much experience with NxStage but my understanding is there is just one bag of fluid that is used to feed each part, but that you still have fluid either pre or post and it is also the fluid that is used on the outside of the filter. The fluid that is outside the filter is considered the dialysate.
Awesome video
Awesome 👏
Thank you!
thank you
Any trouble shooting videos on HD and CRRT. Like if theres blood in the circuit and etc.
I cover some stuff in here: th-cam.com/video/MykvEt9ZrGA/w-d-xo.html
@ICUAdvantage thank youuu
Thanks for the video!
Can you briefly give examples of medium and large molecules that merit clearance?
Glad you liked it. Cytokines and complement products are the main targets.
Excellent explanation of all dear can you explain about highflow CVVH.
Thank you again, but I'm not sure I know what that is?
Dear it's same like CVVH but it's working through two in one function means we use replacement Fliud both side pre and post dilution that why it's kit is also separate
Same principle work here convection
Hi Eddie, by not using the dialysate in CVVH mode, there will be no diffusion to remove solutes, so the solutes are removed only by convection? If that is the case, will CVVH has less effectiveness in clearing the solutes when comparing to CVVHDF mode? Thanks
Yes, much less effective than CVVHDF.
Thank you for the videos. I still struggle to fully understand CVVHDF prescription. If the ‘dialysis dose’ is the total effluent ( that’s ultrafiltration plus the dialysate), we would prescribe 30ml/kg/h for a 70kg patient, that’s 2100ml/h.
In a unit I worked in they do 50%dialysate (1050ml/h) and 50% replacement (1050ml/h) but they don’t have to be 50/50, right? Is that just convention?
If I take no fluid off, the effluent will be 2100ml/h, correct?
If I want to run a negative balance of - 100ml/h, does the machine then replace 100ml/h less or does it pull off 100ml/h more?
Great questions. Do you not run a pre-replacement fluid? Typically the dialysate will run at a much faster rate, and then the pre & post are commonly matched. Don't have to be though. So a typical run rate will be something like 500 pre, 1000 dialysate, 500 post. The actual numbers certainly vary, but as a general idea.
To your question, your effluent, with running the patient even, will be roughly equal to the total volume of all your solutions. Its not exact, but close. This is why we monitor these discrepancies and adjust hourly for them.
If you are running the patient negative, the machine is using variable pressure to create more or less hydrostatic pressure to pull (or really push) more fluid out. It modulates these pressures to ensure the proper fluid removed. Again, not exact, but recorded and adjusted hourly.
Very interesting
Very!
These videos are so helpful! If you wanted to switch from CVVHDF to CVVHD, how would you do that? You mentioned turning down flow rates?
Great question. The difference between CVVHD and CVVHDF is adding hemofiltration (ultrafiltration) to hemodialysis. Think convection here. We drive convection by using the pre or post dilution fluid, which the machine has to pull off that same volume from the blood, creating the large flow of volume and thus the convection with it. If we turned the flow of the pre and post dilution (PBP and Post Filter Replacement if using the Baxter machines) we would remove the convection, leaving us with just the hemodialysis. Hope that makes sense. 🙂
@@ICUAdvantage Great explanation!
Does CVVHD get any heparin since there's no replacement?
It can still be anti coagulated. The goal is to try and preserve the filter which is still being used in all modes.
Quick qestion I was wondering about.What happens if i run the machine with the dialysate on zero and the ultrafiltration or fluid removal on zero?what does the filter remove in that case?since i don`t use dialysate it`s not removing ions,it won`t remove fluids either cause I deactivated it. But will it remove ureea and creatinine?
If I'm understanding what you are asking, if you had no diffusion nor ultrafiltration (and thus no convection) you wouldn't have anything. You would essentially be just running blood through the filter, and I guess maybe having some adsorption happening.
@@ICUAdvantage well on the prismaflex you have the option in cvvhdf to turn off the dialysate by putting it to 0 flow.You also have the option to set the fluid removal to zero.So practically you remain with post and/or predilution.Will the filter remove anything?or it would just run with zero effect?cause i tried it and the efluent bag was still filling up.
@@PREDATOR0140 I see what you are asking now. Ok, so you still have convection taking place with pre/post fluid running as that still needs to be pulled back off, hence the effluent collection. You will still have solute clearance. Pt fluid removal is just about balance for the patient. If you have pre & post both at 500ml/hr, and pt fluid removal set to zero, you'll have 1000ml/hr of effluent collection, driving convection.
You are essentially running as CVVH with no dialysate running.
@@ICUAdvantage when we talk about solute clearence you mean than BUN and creatinin will still be cleared right?what about the electrolites?since there is no diffusion taking place they will be unchanged if i understand it correctly.
Hi! thanks a lot for the amazing sereies. I have a tiny question. How CVVHD may be used for removing fluid? If I understand properly - in that specific mode, we use only diffusion and that help us remove electrolytes but not fluid (there is no hydrostatic pressure or osmosis).
👏🏻👏🏻👏🏻
Thank you!
Pierce Park
2585 Dach Ville
Merci !
Thank you so much for this Salma!
@@ICUAdvantage thank you for this wonderful content
Thanks!
Thank you so much!