post op arf

laura.jansenlaura.jansen
edited May 2016 in CDI Talk Archive
I'm not sure if I should query for acute renal failure. This anterior colon resection patient had low urine output s/p surgery. His labs remained stable (bun 13, creat 0.9, h&h 9.3 & 27.0) but his urine output was low (less than 30ml/h for 13 hrs). He had 2L fluid bolus & was transfused with 2 units prbcs. The MD documented pod#1 output slightly down, pod#2 output much improved after transfusion. Any advice would be great. This particular MD is has not been very cooperative with the program & I want to make sure I am doing the right thing. I am the lone CDS.
Thanks.



Comments

  • judithbatesjudithbates
    edited May 2016
    I would think with the clinical information you've given it is a perfect opportunity to query for ABLA.


    Judi Bates RN, BSN, CCDS
    CDI Specialist
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  • Unknown
    edited May 2016
    I concur. Check the anesthesia notes for the EBL.

    Juan J. Abreu RN, MBA
    CDMP Manager
    2222 Philadelphia Dr.
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  • Unknown
    edited May 2016
    I would not query for renal failure based on the lab although RIFLE states if the urine output is below 0.5ml/kg/hr for at least 6 hours you could be looking at renal failure.
    I don't usually query for ABLA unless the Hgb is 8 or below.
    What was the preop H&H?


    Charlene






  • Unknown
    edited May 2016
    I meant to say the lab values posted here.


    Charlene






  • laura.jansenlaura.jansen
    edited May 2016
    Pre-op h&h was 9.3 & 28.7. I think he transfused due to the low urine output & was trying to increase oncotic pressure? I was not even thinking about abla, the ebl was only 50-100.


  • Unknown
    edited May 2016
    do you have a post op H&H?


    Charlene

  • nbrunson84nbrunson84
    edited May 2016
    I wouldn't query for Ac Renal Failure. It's probably because patient has been NPO for surgery etc.

    However, I agree with others you may have an opportunity to Query for ABLA - check your post op CBC.


  • robert.hodges2robert.hodges2
    edited May 2016
    I don't think my doc's here would go for acute renal failure either if I
    were to query them for something like this. More likely it is simple
    dehydration from the surgery since the renal functions stayed within
    normal range..



    Robert



    Robert S. Hodges, BSN, MSN, RN

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  • laura.jansenlaura.jansen
    edited May 2016
    The patient present with an anemia & has a scope that showed a tumor. The primary MD already documented chronic anemia


  • Unknown
    edited May 2016
    My issue is if the MD were solely trying to increase the oncotic pressure, he would've done so using IV fluids, albumin, or FFP. In your scenario, they chose to use PRBC. My question is why?

    --Juan

  • dogdog
    With giving 2 L crystalloids, the H/H is going to drop later on if the PRBCs aren't given. Without a source of blood loss to account for ABLA, and hx anemia already documented, I would not query for ABLA at this point. You could query for severity sake and ask what condition the MD was treating with the PRBCs, and then you might get lucky.

    Also, even with RIFLE criteria for oliguric ARF, I think a stable creatinine of 0.9 is going to be hard to justify as ARF without some good additional clinical documentation.

    Renee

    Linda Renee Brown, RN, CCRN, CCDS
    Clinical Documentation Specialist
    Arizona Heart Hospital
  • ctrygarctrygar
    edited May 2016
    I query for acute blood loss anemia if there is a change in hemoglobin and there is treatment


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