SLED (Sustained Low Efficiency Dialysis)

Bella RN, BSN, MSN · Jun 8, 2009

In my unit they do. But I am not certified to do SLED. What is the difference between CVVHD and SLED?? I have had pts on CVVHD but dialysis nurse runs it.

AmyCardsNP, RN, NP · Jun 8, 2009

CVVHD is ultrafiltration, which is not the same as hemodialysis. Ultrafiltration is the part of the hemodialysis process where fluid is removed from the bloodstream and is often done with the sole purpose of taking fluid off when diuretics aren't doing the trick, or the kidneys have taken a hit and need relief from fluid overload.

SLED is hemodialysis at a slower rate. A "normal" hemodialysis run is about 3-4 hours, while a normal SLED run is about 8 hours. The blood moves more slowly through the system with a slower ultrafiltration rate, which allows us to do dialysis on our more unstable patients who will not tolerate the fluid shifts of traditional hemodialysis.

On my unit, we run ultrafiltration through the machine by Aquadex. It's fairly simple and the ICU nurse initiates and sees the patient through the process- the patient's don't even need 1:1 care. We have several patients who come in for an overnight stay just for a run of ultrafiltration, and are discharged the following morning.

Bella RN, BSN, MSN · Jun 9, 2009

Wow. thanks for the insight. In my unit they have 3 nurses that can do SLED and it runs for 8hrs and they are 1:1. The CVVHD they call a dialysis nurse to come in for that. They only call a dialysis nurse in for SLED if they need trouble shooting. At this facility--not the best btw--it doesn't appear that the patients fair to well after the SLED. Maybe its due to their protocol.. I don't know--but I don't care for alot of the outcomes there. Thanks again for the info!!

Chisca, RN · Jun 10, 2009

Don't kid yourself if your unit isn't staffing these patients as 1:1 that it's without risk. It is an extracorporeal circuit with at least 300 ml of blood in it, it can clot and it can become disconnected causing exsanguination. Air can enter the circuit causing an embolism. If the patient was stable they would be receiving hemodialysis.

AmyCardsNP, RN, NP · Jun 10, 2009

I said that for ULTRAFILTRATION alone, (aka aquaphoresis) the patients are not 1:1. Using the aquadex system, there is only 33ml of blood in the circuit and the manufacturers website states that 1:1 care is not required. Heck, it even says that ICU care is not required (http://www.chfsolutions.com/ourtherapy_howitcompares.html). I was not talking about SLED with my comment about 1:1 care not being used... just wanted to be very clear here. Ultrafiltration, Hemodialysis, and SLED are all different.

Chisca, RN · Jun 10, 2009

As the web site states "Aquapheresis Therapy with the Aquadex FlexFlow is not dialysis". My comments were specifically directed at nurses who may be led by management to think that SLED does not require 1:1 staffing. SLED has a 46% in hospital mortality rate and it is precisely the instabilty of these patients that requires increased nursing care.

Tish88 · Jun 28, 2009

CVVHD is ultrafiltration, which is not the same as hemodialysis. Ultrafiltration is the part of the hemodialysis process where fluid is removed from the bloodstream and is often done with the sole purpose of taking fluid off when diuretics aren't doing the trick, or the kidneys have taken a hit and need relief from fluid overload.
CVVHD is continuous venous-venous hemodialysis. (ultrafiltration and dialysis together)
CVVH is continuous venous-venous hemofiltration (ultrafiltration with no dialysis components added)
It is used for acute renal patients who can not tolerate conventional 4 hr dialysis treatments.
It is a continuous renal replacement therapy that includes dialysis and ultrafiltration.
We run CVVHD 24 hrs a day on the nxstage machines.
We did SLED years ago before the invention of the newer machines "prisma" and nxstage.
These treatments would always tend to clot off on us. We used the regular dialysis machines (which were modified to run slow) and connected to the R/O (water supply).
The prisma and nxstage machines don't need a water supply - decreases your risk of flooding your unit when someone trips over the water/drain line and does not put it back in the drain!

WalkieTalkie, RN · Jul 7, 2009

We do a lot of SLED on my unit. Some with heparin and some with citrate for anticoagulants. Only the citrate SLEDs are 1:1. We also run SLED around the clock until it clots off. We then return the blood and flush off the dialysis cath and page the dialysis RN and nephrology team.

We also use Aquadex on occasion, and I hate it. It seems to work best only when someone has a real central line, not the stupid Aquadex catheter that only goes in a few inches. I've found that trying to run Aquaphoresis is often times more annoying and time demanding than maintaining a patient on SLED or SCUF. The machine is frequently beeping and pressures are often high. I've only seen Aquaphoresis work well a couple of times on my floor. Just my opinion, but a lot of nurses groan when they find out they have to do Aquaphoresis.

vastudent09 · Sep 6, 2009

So is there a difference between SLED & SCUF?

WalkieTalkie, RN · Sep 6, 2009

So is there a difference between SLED & SCUF?

SCUF just removes fluid and SLED removes wastes and fluids...