Nurse Responsibilities & Clinical Decision Making When Caring for Critically Ill Pediatric Patients Requiring Continuous Renal Replacement Therapy Colleene Young RN, BSN, CCRN PICU Clinical Nurse IV Childrens Hospital Los Angeles

286-Bed tertiary care children’s hospital Affiliated with University Southern California Keck School of Medicine (20 bed PICU; 15 bed CTICU; 40 bed NICU) Hospital admissions annually >11,000 PICU admissions annually >1,100

Training, Competencies & Troubleshooting Training includes one day class & two precepted shifts All critical care fellows are required to attend hemofiltration class Annual skills lab; nurses & fellows attend Circuit changes & troubleshooting measures tracked

Patients/year, Length of Stay & Survival

Nurses present in rounds, actively participates in plan of care Worksheet computes 24º total intake (infusions, meds & flushes) Net (-/+) fluid balance determined; hemoflitration flow rates adjusted

Childrens Hospital Los Angeles Hemofiltration Order Sheets

Hemofiltration infusions, settings, volumes & net hourly fluid balance are documented in the electronic patient record

ECMO trained nurses are required to maintain competency to manage hemofiltration pump PICU nurses also manage CTICU hemofiltration Hemofiltration used commonly as adjunct therapy with ECMO

Your Text here Hemofiltration may be continued when patients require surgery PICU nurses manage hemofiltration intra-operatively Study demonstrated benefit of CRRT during orthotopic liver transplantation Patients with hepatic disease at risk for acute kidney injury Maintaining an even or negative fluid balance beneficial

Colleene Young RN, BSN, CCRN PICU Clinical Nurse IV Childrens Hospital Los Angeles Pediatric Intensive Care Unit 4650 Sunset Blvd MS # 74 Los Angeles, CA USA +1 (323) Thank You!