Re: CRRT Originally Posted by tryingtohaveitall 
To be honest, as one of the original core group, I do have concerns that the staff given a perfunctory orientation aren't familiar enough to be able to troubleshoot the system well. Kind of like reading how someone here said they went through, I think it was 14 sets in a day. Wow! That's a lot of circuits and I can't help but think they had a catheter that wasn't allowing for good flow or there was some other significant problem.
Originally Posted by pebbles 14 in one day!!! We have standing orders to get the nephrologist to assess if we go through more than 2 in 24 hours.
I'm the person who posted about the 14 sets in 24 hours. (The OP is also 7 years old...) Let me explain how that came to be... The patient was 9 months old and had fallen head-first into a 5 gallon pail of human waste. At the time we tried to establish CRRT on this patient we were battling MODS, DIC, chemical pneumonitis and a host of other problems. The edema from so many issues made it difficult to do anything, and the biggest vas-cath we were able to get was an 11Fr. At the time the PICU was not running CRRT at all; if we had a kid who needed it, the adult dialysis unit or the adult MICU sent us someone. The nurses who were assigned to this patient over the 24 hour period we were attempting to get things going were both highly trained and very experienced CRRT providers. We consulted nephro several times and had someone on the unit most of the day. We had problems with the access pressure from the get-go. The filter clotted after maybe 30 minutes each time, despite our best efforts. The dialysis nurses made their views known early in the game that this wasn't going to work, the catheter was too small, the DIC would be in issue and so on. The PICU medical director and the nephrologist wanted us to keep going, and so we did. After 24 hours, it was agreed that the child was not salvageable and we finally gave up on CRRT. Death came about 5 hours later.
Originally Posted by tryingtohaveitall I'm curious to get my hands on the new machine and see how it runs.
We're using the PrismaFlex in the unit where I work now. The staff who are responsible for CRRT really like it. We've successfully dialysed an infant continuously for the last four months with it; sometimes the circuit needs to be changed after 3 days, and sometimes it lasts a week. All depends on what else is happening with the patient.
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