CRRT

Our unit is being pushed to begin providing CRRT. In the last three years or so, we have only had an average of four patients each year who required it. In the past we have provided all PICU care and had either a dialysis nurse or a nurse from the adult ICU run the equipment, but are being told this practice is no longer viable due to staffing shortages (which we are also experiencing). We have a number of concerns about getting started on this path. For example, we have just emerged from under the Pediatric Cardiac Inquest, the longest medical inquest in Canadian history; one of the major points made by the justice in the report was that our hospital did not perform enough cases to maintain skills. We're worried that this will be the case with CRRT. How many cases would be considered enough? One of our CRRT patients last year was an infant; in a 24 hour period we went through 14 filter sets and 7 units of blood before he died. Can we justify this kind of equipment usage? We understand that the learning curve will be fairly steep; how can we provide adequate staff to allow 2 nurses to 1 patient when some days we have to divert patients out of province because we don't have staff to care for them? I'd appreciate hearing about how other units are doing CRRT...