Critical care nurse
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Critical care nurse · Apr 2016
ReviewContinuous Renal Replacement Therapy and Anticoagulation: What Are the Options?
Continuous renal replacement therapy is currently used as a standard treatment for acute kidney injury in the intensive care unit, particularly for patients with unstable hemodynamic status. Because this therapy is continuous, for days or weeks, and the extracorporeal blood circuit is large, the circuit is prone to clotting. Several methods of keeping the extracorporeal circuit patent are available, including heparin infusion, flushes with physiological saline, use of thrombin inhibitors, and citrate. This article reviews methods for continuous renal replacement therapy, anticoagulation, efficacy, and implications for bedside critical care.
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In the December Ask the Experts article by Alexander and Zomp, “Best Practices: Full-Dose Delivery of Intravenous Medications via Infusion Pumps” (Crit Care Nurse. 2015;35(6):68–70), the authors would like to clarify that the Alaris pump referred to on page 70 is an older version and that the max rate is now the same for both primary and secondary settings on Alaris pumps (999 mL/h).
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Critical care nurse · Apr 2016
Application of Antibiotic Pharmacodynamics and Dosing Principles in Patients With Sepsis.
Sepsis is associated with marked mortality, which may be reduced by prompt initiation of adequate, appropriate doses of antibiotic. Critically ill patients often have physiological changes that reduce blood and tissue concentrations of antibiotic and high rates of multidrug-resistant pathogens, which may affect patients' outcomes. All critical care professionals, including critical care nurses, should understand antibiotic pharmacokinetics and pharmacodynamics to ensure sound antibiotic dosing and administration strategies for optimal microbial killing and patients' outcomes. ⋯ Time-dependent antibiotics, such as β-lactams, can be given as extended or continuous infusions. Concentration-dependent antibiotics such as aminoglycosides are optimized by using high, once-daily dosing strategies with serum concentration monitoring. Vancomycin and fluoroquinolones are dependent on both time and concentration above the minimum inhibitory concentration.