AKI transfer policy - ward to Ward 7b GRH

(or transfer from CGH)

Transfer may proceed if the following criteria are met

All AKI 3 patients or patients with complications must be assessed as safe for transfer by a registrar

Hyperkalaemia

No ECG changes

K < 6.0

If K lowered to < 6.0 after presentation this must be potentially sustained (e.g. bicarbonate therapy or dialysis/CVVH) not transient therapy (insulin and dextrose)

Renal Acidosis

pH > 7.2

Bicarbonate > 12

Lactate < 4

Respiratory rate < 24 / min

(NB Renal Acidosis does not have the same prognostic implications as acidosis due to hypoperfusion)

Respiratory

Respiratory rate < 24 / minute

Saturations > 94% not requiring more than 40% oxygen

If patient required acute CPAP, must have been independent of this treatment for 24 hours

Circulatory

HR < 120 / minute

BP > 100 mmHg systolic

MAP > 65 mmHg

Lactate < 4

(lower BP values may be accepted if it has been firmly established as pre-morbid)

Neurological (uraemic encephalopathy)

GCS > 12

IF CRITERIA NOT MET, CONSULTANT ONLY REFERRAL TO CRITICAL CARE

Once stabilised, follow ‘ITU to acute kidney unit transfer policy’

Transfer target post stabilisation 24 hours