ICU RN's doing CRRT vs HD

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My co-workers and I are in a situation right now that many are feeling uncomfortable with. I work at a fairly small hospital with a 16 bed ICU where CRRT isn't rare, but several of us don't have a lot of experience with. For traditional HD we contract with a company to come in and run therapy on all patients in the hospital including ICU patients. For reasons unknown to me this company pulled out of their contract and we were told it would be 2-3 weeks until another company will be replacing them. One of our nephrologists suggested the ICU nurses could run a very intensive CRRT treatment on HD patients over 4 hours with dialysate (12 L/hr), ultrafiltration (1 L/hr), and blow flow rates (350-450 ml/min) higher than any of us have had experience with since CRRT is such a slow therapy over an extended period of time. For floor patients we would only run 1 at a time, and for ICU patients they would be a 2:1 patient so someone could be managing vents, drips, etc and one managing just machine/dialysis. Yesterday we had our first 2 patients that we used these types of settings, both on vasoactive drips though one was hypotensive (did not tolerate and lowered settings to traditional CRRT) and one hypertensive (tolerated very well and able to remove target fluid amount).

I have 5 years experience in ICU, but only about a year of experience with CRRT and since we don't do CRRT everyday or even every week I still feel like a novice at this. Are these intensive treatments anything that anyone else has performed with only CRRT experience? Is what they are asking of us unsafe? And could our license be at risk since we have no experience with traditional HD?

I would so appreciate any and all feedback that you guys could give me here! - Thanks!

Greenclip

100 Posts

This would never come up in our ICU because I am in a huge hospital. I can tell you though that CRRT can definitely be used like that. With a nephrologist supervising and 2:1 staffing on the patient, I would be very comfortable doing it. I would not see my license being at risk. The nephrologist's recommendations are on target, you are staffing appropriately, and responding appropriately (settings were lowered for the hypotensive patient).

I think you and the other nurses are going to feel much more confident using CRRT by the time you get a new HD contractor on board.

I'm a novice nurse in the icu, but peak in on the crrt to be exposed to it. At our facility crrt is a 1:1, you are very lucky to be 2:1

VANurse2010

1,526 Posts

I'm a novice nurse in the icu, but peak in on the crrt to be exposed to it. At our facility crrt is a 1:1, you are very lucky to be 2:1

Just to let you know, it's not really the norm anymore for CRRT to be 1:1. Don't surprised if you go somewhere else and find a normal 2:1 ICU ratio with one of the two on CRRT.

Specializes in ICU.

This will be a learning curve for sure. sucks that they have to resort to this, but you need to do whats best for the patient, and they need dialysis! I havent done CRRT in a few years, but when I did, there were some patient we would do "high flow crrt", i think is what it was called. I think it was part of a study something to do with rhabdo and waste product clearance if I remember right. We staffed 2 nurses/1 patient because we were mixing bags and changing them every 45 min etc, but it is totally possible. You guys should be fine and you will feel much more comfortable with it now!

KerBearRN31

2 Posts

Thank you so much Greenclip and Creamsoda! I am glad to know that others would feel comfortable with these settings. When I hear people telling me that my license could be on the line, I get a little anxious. I will have to do some more research on "high flow crrt" and hopefully get some good information to pass along to my co-workers.

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