Plasma-lyte^® as dialysate for CRRT: institution of a new therapy and initial evaluation

Introduction

At the R Adams Cowley Shock Trauma Center, dialysate for CRRT has traditionally been 0.9% saline with 0.5 amp sodium bicarbonate/l. Replacement fluids were 0.9% saline or 0.45% saline with additives adjusted as indicated by laboratory results. Plasma-lyte^® was suggested as a new dialysate due to its electrolyte composition.

Methods

Prior to institution of Plasma-lyte^® as dialysate, a review of existing dialysis and replacement fluids and electrolyte additives was undertaken. Disposables were recorded and a cost review was done. Dialysate was then changed to P-lyte^® with close monitoring of laboratory parameters to identify metabolic or electrolyte abnormalities. Relative costs were compared. ICU nurses were polled with regard to ease of use.

Results

The average daily cost of all IV fluids for dialysate, replacement fluids with additives and disposables was US$71.00. (Does not include circuitry/filters.) The cost of P-lyte^® is $1.72/l, compared to $0.70 of 0.9% saline and $0.75 for 0.45% saline. The pH of P-lyte^® is 7.4 and the pH of 0.9% and 0.45% saline is 5.0. The composition of the various fluids is listed in the Table (in mEq/l).

Table

There were no major metabolic abnormalities identified due to the use of P-lyte^® as dialysate. One patient developed and maintained a serum K⁺ > 5.0 and the P-lyte^® was discontinued. The nursing staff consistently rated the use of P-lyte^® as superior to the saline solutions due to: (1) convenience of use, (2) improvement of serum electrolyte composition (leading to discontinuation of mixing multiple bags of replacement fluids), and (3) less risk of error. The costs were felt to be comparable, because of a decrease in the need for numerous electrolyte additives to the replacement fluids (and the disposables associated with this).

Conclusion

Plasma-lyte^® appears to be a safe, cost effective and physiologic dialysate solution that can be used with ease. Diffusive losses of magnesium should be minimized with P-lyte^®. Hyperglycemia is minimized due to a lower glucose content than that found in Dianeal^®. The chloride load presented by isotonic dialysates should be reduced with the use of Plyte^®. P-lyte^® is now the first-choice dialysate and replacement fluid at the Shock Trauma Center for CRRT.