CRRT: Is it a dialysis or a Critical Care procedure?

[NephRN]

I am a dialysis nurse working in an inpatient, acute care setting. Where I work, the dialysis staff sets up the CRRT (PRISMA), provides teaching to the critical care staff, changes the set-up when the sytem clots, makes the changes when there is a change in modality ordered (ie: SCUF to CVVHD), on call for problems, and discontinues the treatment when so ordered. Please tell me how it is handled where you work. I would also like to know what area you work in (ie: ICU, CCU, SICU, TICU, CVRR, Dialysis, etc.) and how you feel about your CRRT resonsibilities. Thanks in advance.

[CC NRSE]

Hi! Where I work, (we basically have a combined unit- assigned daily to particular unit) ICU,CCU,MICU,CVCU, we set up and maintain the BM-11 (old form of the Prisma) It is a major PAIN!!!! ALWAYS clots off. They are currently trying to get dialysis involved where they will set-up. Then all we would have to do is maintain it. That would be SO much better for us. For me, I can maintain and keep it running but not real good at setting it up by myself. We don't use it very often. I have worked with the Prisma (at another hospital) and did have to set it up again (clotted off). I thought it was pretty easy, at least compared to the BMer (as we call it!!).

I guess our hospital is working toward what you have. I personally think it will be better in the long run once this is in place. Currently, we have no one to call except the MD if something gos wrong with our machine. This usually results in stopping the CVVHD D/T not know how to set it back up. We currenlty have ALOT of new (green) nurses!!!

[Janet Barclay]

Hi Neph RN,

I work in a 24 bed general systems ICU where the bedside nurses are entirely responsible for both CRRT and Hemo runs on our patients, from set up to tear down. We are also doing TPE via the PRISMA machine, though not very often. We all find CRRT very easy to run as the Hospal machine is very user friendly. We recently bought two ew Integra machines for hemo and have had a bit more challenge figuring them out:) . We don't do anything fancy with our hemo (no profiling or ramping), and generally muddle throuhg pretty well.

[beanbag]

Hi, I work on a general ICU. Before I qualified as a RN I worked as a NA on a heamodialysis unit in 1994, this was in the time that the ICU did not use CRRT and the staff from the Haemo unit would be 'on call' for ICU and other acute renal patients.. Now ofcourse on ICU we use PRISMA machines.

The ICU staff sometimes see this as a drain on their time and effort but on balance probably prefer having more control over the patients care. Having talked to old workmates they obviously prefer not to be on call for ICU as well as there own patients.

The only downfall is that sometimes I think we are told the technical side of the PRISMA but are not always 100% sure of the renal systems we are supporting unlike the specialist renal nurses, I can only talk about my instance as I am still quite a 'green' in my general knowledge and know my limitations. It would be ideal if specialist renal nurses could maybe do more teaching input on ICU as I'm sure this would be benificial to staff and patients in the long run.

[booklady]

We have a busy, very mixed ICU, 16 beds, We do it all. We have a really strong in-patient dialysis staff that sets up the Prisma and changes out the filter when needed. We do everything else. They do round and check on out pt's to make sure everything is looking good. It messes up our productivity as they are almost always one on ones. The staff likes to do it, usually fight over it.

[PButler]

Hi,

In the Trauma/surgical ICU and MICU at our busy university hosptial, the nurses do everything related to CRRT. We set up the prism and run it. Pts on CRRT are usually 1:1 to allow for the nurse to run the machine and still take care of the pt. We used to use the Baxter system but switched to prism a couple of years ago. The prism is high tech and user friendly. It is much easier to run then the baxter.