NURSING CHALLENGES IN CRRT Sue Taylor Nursing CRRT Lead
Background CRRT history Total PICU admissions at KCH was 1273 over last 2 years. Children’s Critical Care performed CVVH in 71 patients in the last 2 years ( 476 episodes) Total CVVH bed days = 1643 Of these, 173 episodes were for Acute Liver Failure
Nursing expectations Following the decision to perform CRRT bedside nurses are responsible for the setting up and priming of the CVVH machines Ensuring the prescriptions are available and correct Preparing and commencing of treatment Performing bedside ACT and initiating intervention if required Calculation of patients daily fluid requirements and adjustments. Discontinuing treatment when indicated by physician
Training at King’s “How training on CRRT has evolved over the last few years at King’s” Didactic and interactive teaching sessions ½ day for all grades of staff Didactic and ½ Simulation training day for all grades of staff – Simulation lead training day including extensive trouble shooting using previous Adverse incidents reported Documentation of individuals skills in CRRT using competency framework records
Nursing ratios for CRRT PICS standards state; Ventilated patients receiving CVVH = 1.5/1 Non ventilated patients receiving CVVH = 1/1(cubicle) 0.5/1 In reality; Increased bed usage and staff shortages due to sickness/ maternity and vacancy are less flexible and therefore patients receiving CVVH do not always get the correct nursing ratio they deserve.
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