- Fill in the Prescription in Effect and filter start time once per shift (or whenever the order changes) — the prescribed dose and filter age update automatically.
- Chart circuit pressures and anticoagulation hourly in the first table, and the fluid-balance ledger hourly in the second — Total Intake, Hourly Balance, and Cumulative Balance calculate themselves as you type.
- Enter hours CRRT actually ran this shift in the Quality Metrics box to see the live delivered:prescribed dose ratio against the >80% target.
- Log labs and any alarms/events/circuit changes as they occur — total downtime sums automatically.
- Complete the SBAR box at end of shift, then click Print / Save as PDF (bottom-center pill) to hand off or file in the chart.
Everything you type is saved in your browser only (localStorage) — nothing is sent anywhere. Use Reset Form below to clear it for the next shift/patient.
When to Use
Use this template for every CRRT shift as the working flowsheet at the bedside, or as a structured starting point to adapt into your unit's electronic or paper charting system. It operationalizes the Documentation & Monitoring section of the CRRT Clinical Reference guide — the same monitoring cadence, required flowsheet fields, and SBAR handoff structure, made fillable and self-totaling.
Appropriate use
ICU and dialysis nurses/techs charting an active CRRT shift; nephrology/IM trainees learning what a complete flowsheet should contain; attending physicians auditing delivered vs. prescribed dose or reviewing a shift's fluid balance at handoff.
Not a substitute for your EMR
This is an educational, print-first template — it does not replace your institution's validated electronic or paper CRRT flowsheet, does not transmit or store data anywhere but your own browser, and is not a medical device. Reconcile every field with your unit's protocol and documentation policy.
Charting Tips & Pitfalls
Chart the trend, not just the value
A single pressure reading means little — what matters is the direction of change from baseline. Fill every hourly cell you can, even when "unchanged," so the trend is visible at a glance at handoff.
Downtime is data
Every hour off therapy lowers the delivered dose. Log the reason, start, and stop time of every interruption in the Events table — the total downtime figure is what explains a low delivered:prescribed ratio at the end of the shift.
Pitfalls
(1) Don't forget to update the Prescription in Effect box whenever the order changes — the dose calculations use whatever is currently entered there. (2) The Cumulative Balance column only totals rows you've filled in order, top to bottom — a skipped row will not be included. (3) iCa values (post-filter vs. systemic) are two different targets — never chart one in place of the other (see the CRRT guide's Anticoagulation section). (4) Reset the form between patients/shifts so figures don't carry over.
Why Use It
Rigorous documentation is a patient-safety intervention, not paperwork: it is how a rising TMP or a creeping cumulative fluid balance is caught early, how a delivered dose that has quietly fallen below target is discovered before it becomes clinically meaningful, and how a shift handoff transfers the full clinical picture instead of a verbal summary. Building the fluid ledger and dose-ratio math directly into the form removes the arithmetic errors that come from hand-totaling a 12-hour ledger at 6 a.m., and a structured SBAR box ensures nothing is dropped between shifts — the same four questions, every time.
Prescription in Effect & Filter Age
Update this box whenever the order changes. The prescribed effluent dose and filter age recalculate live.
⚕ KDIGO target: delivered effluent dose 20–25 mL/kg/hr — prescribe ~25–30 to offset downtime. Filter age auto-refreshes about once a minute while this page stays open.
Hourly Circuit Pressures, Anticoagulation & Fluid Balance
One row per hour (or your unit's charting interval) across a 12-hour shift. Total Intake, Hourly Balance, and Cumulative Balance calculate automatically as you fill the fluid ledger.
Circuit Pressures & Anticoagulation
| Time | Access (mmHg) | Return (mmHg) | TMP (mmHg) | Pre-filter (mmHg) | Citrate (mL/hr) | Ca infusion (mL/hr) | Post-filter iCa (mmol/L) | Systemic iCa (mmol/L) | Init. |
|---|
Fluid-Balance Ledger
| Time | Effluent (mL) | Net UF removed (mL) | Replacement returned (mL) | IV fluids (mL) | Nutrition (mL) | Blood products (mL) | Flushes (mL) | Total Intake (mL) | Hourly Balance (mL) | Cumulative Balance (mL) |
|---|
Fill the fluid ledger and enter hours running to see the delivered:prescribed ratio.
Labs, Electrolytes & Events Log
Chart labs as drawn (typically q6–12h, more if unstable) and every alarm, intervention, or circuit change as it happens. Total downtime sums automatically.
Labs & Electrolytes
| Time | K⁺ (mmol/L) | Na⁺ (mmol/L) | HCO₃⁻ (mmol/L) | Phosphate (mg/dL) | Magnesium (mg/dL) | pH / acid–base | Notes |
|---|
Events, Alarms & Circuit Changes
| Time | Alarm / Event | Intervention | Filter/circuit changed? | Downtime (min) | Init. |
|---|
Total downtime this shift: 0 min — every minute here lowers the delivered dose above.
Structured Handoff — SBAR
Complete at end of shift. This mirrors the SBAR structure in the CRRT guide's Documentation & Monitoring section.
Charting Tips at the Bedside
Use the flowsheet to catch problems early, not just to record them after the fact.
- Rising TMP or pre-filter pressure trend: flag it the hour you see it start, not once the filter clots — see the CRRT guide's Troubleshooting & Alarms section.
- Cumulative balance drifting far from goal: reconcile against the whole-patient daily fluid-removal target and adjust net UF, don't wait for end-of-shift.
- Delivered:Prescribed ratio < 80%: look at the Events log for the downtime driver (clotting, access, procedures) before the next shift starts.
- Post-filter vs. systemic iCa: titrate citrate to the post-filter value and the calcium infusion to the systemic value — they are two separate targets, never one dial for both.
- Pair with the CRRT Dose and Net Ultrafiltration Rate calculators when titrating the prescription mid-shift.
Evidence & References
Formulas used on this page
| Quantity | Formula |
|---|---|
| Prescribed effluent dose (mL/kg/hr) | (Qd + Qr + Net UF goal) ÷ weight (kg) |
| Filter age (hours) | (Now − filter/circuit start) in hours |
| Total Intake, per hour row (mL) | Replacement returned + IV fluids + Nutrition + Blood products + Flushes |
| Hourly Balance (mL) | Total Intake − Net UF removed (that row) |
| Cumulative Balance (mL) | Running sum of Hourly Balance, top to bottom |
| Delivered dose (mL/kg/hr) | Total effluent delivered (mL) ÷ weight (kg) ÷ hours CRRT running |
| Delivered : Prescribed ratio | Delivered dose ÷ Prescribed dose × 100% |
The 20–25 mL/kg/hr delivered-dose target and the >80% delivered:prescribed quality metric are both KDIGO-anchored and reinforced by the RENAL and ATN trials, which found no benefit to intensities above the target — the clinical priority is reliably delivering the target dose, not exceeding it. SBAR (Situation–Background–Assessment–Recommendation) is a widely adopted structured-handoff format shown to reduce communication-related errors in critical care handoffs.
References
- Kidney Disease: Improving Global Outcomes (KDIGO) AKI Work Group. KDIGO Clinical Practice Guideline for Acute Kidney Injury. Kidney Int Suppl. 2012;2(1):1–138.
- RENAL Replacement Therapy Study Investigators; Bellomo R, et al. Intensity of continuous renal-replacement therapy in critically ill patients. N Engl J Med. 2009;361(17):1627–1638.
- VA/NIH Acute Renal Failure Trial Network; Palevsky PM, et al. Intensity of renal support in critically ill patients with acute kidney injury. N Engl J Med. 2008;359(1):7–20.
