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How to manage CLAP?

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  To manage the CLAP, it is critical to maintain smooth perfusion during and after surgery. (Water flow test: flow test).

Immediately after returning to the ward, start infusion from iMAP and iSAP. Make sure the circuit is open, as it may already be blocked by a blood clot.

During treatment, check to see if fluid is leaking from the insertion site, pooling under the skin or soft tissue, and if the iMAP pin is loose.

The dosage of gentamicin is 1,200 μg/ml for both iMAP and iSAP, and 2 ml/h for each route. Local gentamicin concentrations are expected to reach a plateau after approximately 2 days. Gentamicin blood levels are monitored once 2-3 days after starting CLAP, and then twice a week (Therapeutic Drug Monitoring: TDM).

The recommended blood concentration of gentamicin is 1 μg/ml or less of the trough value, and if the blood concentration exceeds 1 μg/ml, a reduction in the dosage concentration will be considered. Discontinuation will be considered if the dose is 2 μg/ml or more.

The timing of the end of treatment is difficult, but it will be removed when the clinical picture and blood test data improve. First, stop the infusion, and remove the tube when the drainage from the drainage tube becomes almost zero.

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