Back to the Basics
Which catheter site has the lowest risk of complications?
Internal Jugular Vein
The TMP is increasing and you experience a “Advisory: Filter is clotting” alarm. You can troubleshoot this and decrease TMP by:
Increasing blood flow rate and decreasing patient fluid removal.
Your machine has passed the prime test, how long do you have before you have to attach your patient.
after 60 min the recommendation is to reflush.
Bonus 50 points:
Why do we want to flush?
If the goal of treatment is to perform mostly convective therapy, what type of solution will be used?
Replacement
What is the temperature range on the Thermax?
35 and 38 degrees
You want to call your TS to discuss an alarm you cleared. You cannot remember its name. To check the name of the alarm, you can:
Review the "Events" screen under History
24 hours! Even if you remove it from the plastic and don't mix, it is still only 24 hours.
At start-up, a preventive maintenance reminder appears on the screen. Do you forget about it, send the machine to biomed immediately or continue using the machine?
Keep using machine. Let biomed/tech know the preventive maintenance (PM) is due, but machine in use
Which flow setting may potentially impact patient hemodynamics?
Patient Fluid Removal
How much volume does a thermax disposable bag hold?
27 ml
What are three things we can do to prolong filter life?
Ensure adequate anticoagulation.
Increase BFR
Prefilter replacement
Lower patient fluid removal
Use larger filter
What is the main reason you use Prism0CAL for citrate runs?
Because it has no Calcium.
You have a negative TMP. What is one thing you can do to normalize the TMP back to the patient's baseline?
Do a self test. It will zero all the pressures on the machine back to baseline.
You would need wait. This is an automatic therapy recovery.
Your patient has a very high replacement and dialysate flow rate due to sepsis. Suddenly your Thermax alarms, "Return blood temperature low for Thermax - T2291". How would you troubleshoot this alarm?
Decrease the BFR
Decrease the post- replacement rate
Decrease the return temperature
CAUSE: incompatible perscription
What are the key indicators used to stage AKI?
Serum Creatinine
Urine Output (mls/kg/hr)
The RENAL study cites patient’s receiving CRRT are underdosed as much as 25-35% in the real world (non-study related conditions). What impacts the delivered dose?
1.Pauses in therapy (e.g., bag changes)
2.Alarms (e.g., access extremely negative)
3.Down time/off of machine (e.g., out of ICU, filter changes)
In which screen can you can find the cumulative fluid totals which will reflect your unit flow sheet start time?
History screen
A BLD Alarm has occurred. No signs of blood in the effluent are noted... what can we do to troubleshoot?
Draw an effluent sample and send it to the lab to test for the presence of RBCs.
50 Bonus Points:
If it is negative, where can we "Normalize Blood"
You are moving your Prismax from ICU bed 1 to ICU bed 10. Once you arrive at your destination, the Prismax Alarms "Thermax Communication Lost". What could have caused this alarm?
Thermax communication is lost when running on battery power. Once outlet power has been restored, end user is prompted to turn thermax power switch back on. The connection could have also become loose during transport.