A patient in the intensive care unit is receiving continuous venovenous hemofiltration for acute kidney injury. Which of the following is needed to successfully provide the treatment for the patient?
1. a small pump
2. successful placement of the catheter in an artery and a vein
3. infusion of a dialysate through the hemofilter
4. a fistula
1
Rationale: Continuous venovenous hemofiltration uses a double-lumen catheter placed in a vein. This eliminates the need for an arterial catheter and the associated risks of this device. Without the arterial pressure to "drive" the system, a small pump propels the blood from one lumen of the catheter through the hemofilter and back into the vein through the second lumen. The pump controls the blood flow and therefore the fluid removal rate. The infusion of a dialysate through the hemofilter is used with continuous arteriovenous hemodilution and continuous venovenous hemodilution. A fistula is needed when the patient will be on long term hemodialysis.
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