CRRT Initiation/Management Note

Date/Time: [Date and time of note entry]

Provider/Service: [Author name, role, and service/team]

Note Type: [Initiation / Daily Management]

ICU Location: [ICU unit and bed]

Reason for Note: [One-line primary indication or management focus]

Clinical Context and Indication

[Brief narrative (3–6 sentences) establishing why CRRT is indicated now: kidney diagnosis framing, hemodynamic context including shock state and vasopressor requirements, fluid status trajectory, and why medical management alone is insufficient.] (For initiation notes, explicitly prioritize urgent indications such as refractory hyperkalemia, severe acidosis, volume overload unresponsive to diuretics, uremic complications, or hemodynamic instability. For daily notes, succinctly restate the ongoing indication and any interval changes.)

Key Objective Data: [Dosing weight with source; current vasopressor(s) and dose(s) with MAP; recent I/O and urine output trend; critical labs with timestamps including potassium, bicarbonate, pH, BUN/Cr, phosphate, magnesium, ionized calcium, lactate, and coagulation parameters as relevant] (If values are pending, state explicitly when they will be rechecked.)

Therapy Goals: [Target electrolyte ranges; acid-base targets; fluid balance goals with time horizons; azotemia reduction goals if applicable] (For daily notes, update targets only if changed.)

Vascular Access: [Catheter type, size, site/side, placement date; confirmation of position and function; any access limitations] (If access details unavailable, state limitations and plan to confirm.)

CRRT Prescription

• Modality: [CVVH / CVVHD / CVVHDF] (Include brief rationale if initiation or if modality changed.)
• Dose/Effluent: [Weight used and source]; [Target effluent dose in mL/kg/hr]; [Calculated target effluent in mL/hr]; [Prescribed effluent in mL/hr accounting for expected downtime] (KDIGO-recommended delivered dose is 20–25 mL/kg/hr.)
• Flows & Solutions: [Blood flow rate in mL/min]; [Dialysate flow in mL/hr with solution composition including K, buffer, and calcium]; [Replacement fluid flow in mL/hr with pre/post-filter distribution and solution composition] (Include only flows applicable to selected modality.)
• Net Ultrafiltration: [Net UF rate in mL/hr] [fixed / titratable]; [Titration parameters]; [Hemodynamic guardrails including MAP threshold and pressor limits]; [Who has authority to adjust UF]
• Anticoagulation: [Regional citrate / Systemic heparin / None] (Anticoagulation plan must be explicitly documented and cannot be inferred from labs or other data.)
  • (If regional citrate) [Protocol name; post-filter iCa target; systemic iCa target and calcium replacement settings; monitoring frequency; contingency for citrate accumulation]
  • (If systemic heparin) [Infusion rate; aPTT or anti-Xa target; monitoring schedule; contingency for bleeding]
  • (If none) [Explicit rationale; expected filter life and mitigation strategies]

Management Plan

• Monitoring: [Lab frequency and panel]; [Circuit performance metrics and check interval]; [Delivered vs prescribed dose tracking method]; [Downtime tracking approach]
• Electrolyte Strategy: [Potassium: dialysate K selection and repletion thresholds]; [Phosphate: solution selection and/or supplementation plan]; [Magnesium: monitoring and repletion]; [Calcium: targets and replacement, especially with citrate]; [Acid-base: buffer selection and target bicarbonate/pH]
• Escalation Triggers: [Conditions requiring prescription change or urgent intervention, such as refractory electrolyte/acid-base derangements, inability to meet fluid goals, frequent filter clotting, or worsening clinical status, with planned response for each]
• Weaning/Liberation Criteria: [Hemodynamic stability]; [Improving urine output]; [Stable electrolytes and acid-base]; [Ability to maintain fluid balance without continuous therapy]
• Trial-Off Strategy: [Pause-and-monitor / Transition to intermittent HD]; [Monitoring during trial]; [Criteria for restarting therapy]

Delivered Therapy Summary

(Include for Daily Management notes only.)

• Therapy time: [Total hours on therapy in last 24h]; [Downtime duration and reasons]
• Delivered dose: [Delivered effluent in mL/kg/hr]; [Comparison to prescribed with reasons for any shortfall]
• Current status: [Prescription unchanged / adjusted with details]; [Complications and actions taken]; [Planned changes with rationale]

(If course stable with no active issues, state: "Course stable; no active CRRT issues; continue current prescription and monitoring.")