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Members:
Our PICU docs are about to start using CVVH (Continuous Venovenus
Hemofiltration) in the unit. Our Pediatric Clinical staff consist of me and
1 part-time staff RPh. I have only seen the procedure once in a hospital
400+ miles away. Now the questions.
1) How many of you out there are familiar with CVVH in your present or
immediate past institution?
2) How much is the pharmacist involved in the set-up and monitoring of CVVH?
Our docs expect me and our "team" to monitor all drug levels and adjust
doses as needed once CVVH is turned on.
3) Is there any literature out there concerning drug clearance in CVVH that
is not covered by dialysis?
Any additional advice/warning would be appreciated.
Please respond to me personally. I don't think the list would be too very
interested.
Robert Aucoin
Baton Rouge, La.
RGAucoin.aaa.AOL.com
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Their are several forms of this dialysis procedure. CVVH,CVVHD,CAVH,CAVHD.
We have used CVVH,CVVHD most recently at our institution. The seiving
coefficient can depend on the filter used. In general I will follow the
start time, blood flow, dialysis filtration rate and ultrafiltration
rate, and daily fluid removed. Depending on the patients problems, emperic
dosing is done on the
limited available literature for CVVH or CAVH seiving coefficients. Most
of the children requiring CVVHD would be individually unique, making it
even more of a challenge. For those agents that drug levels are
available, I will calculate a clearence rate during the CVVH and adjust
accordingly with changes in the dialysis. For severe infections,
aminoglycoside levels are kept between 3-7mg/l, and vancomycin above
10-15mg/l (depending on assay error secondary to CDP-1).
Some references to help get you started are:
1. Bressole F et al. Clinical Pharmacokinetics During Continuous
Haemofiltration. Clin Pharmacokinet 1994;26 (6):457-471
2. Armstrong DK et al. Vancomycin and Tobramycin clearance in a n infant
during continuous hemofiltration. Annals of Pharmacotherapy 1993;27:224-227
3. Thomson AH et al. Gentamicin and Vancomycin removal by continuous
venovenous hemofiltration. Annals of Pharmacotherapy 1991;25:127-129.
Good Luck.
Willaim Dager, Pharm.D.,FCSHP
Coordinator, Pharmacokinetic Consult Service
UC Davis Medical Center
e-mail: wedager.-at-.ucdavis.edu
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William,
Thank you for the info. I'm putting together a packet of info on CVVH that
has been sent to me from around the country. If I can help you with
anything, give me a shout.
Robert Aucoin
RGAucoin.-a-.aol.com
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I would add:
Reetze-Boroden P, Bohler J, Keller E. Drug dosage in patients during
continuous renal replacement therapy. Clin Pharmacokin 1993;24:367-379.
This article contains a lengthy table of suggestions for dosage
adjustments, depending on the type of continuous therapy that is being
used, and organises the information by drug class.
**********************
Randy Trinkle, BScPharm, BA
Dept. of Pharmacy
Dawson Creek & District Hospital
Dawson Creek, BC
rtrinkle.-at-.pris.bc.ca
**********************
"When the wind blows, the cradle may rock,
but the ideal gas laws still apply."
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