1. Current State of Pediatric Continuous Renal Replacement Therapy (PCRRT): A National Survey AJ Tanner, RN, BSN, ML Heard, RN, TL Young, RN, BSN, SF Wagoner, MBA, RRT April J. Tanner, RN, BSN Advanced Technologies Coordinator Children’s Healthcare of Atlanta at Egleston

2. A National Survey  An national review of current trends in CRRT  An 18 question survey sent to pediatric centers that offer CRRT free-standing or based in adult facility  42 centers responded

3. Therapy Types

4.  22 of 42 centers offer all available therapies  Mean PCRRT pts per year: 12.8 (1-60)  Median pts per year: 9 50% of centers have <10 patients per year  Average daily census of ICU’s: 13 range of 5-27

5. System Set-up

6. Staffing Ratios

7. Logistics and Coordination of System Set-up  11 of 42 centers have no formal 24/7 coverage  In 93% of center’s RNs manage the pump dialysis, ECMO, and physicians make up the other %  Charge structure the dept.that sets up equipment receives revenue in majority of centers 21 of 42 centers also have daily charges varied response as to where revenue goes

8. Managing the Program

9. Education  Wide variety of teaching methods  Didactic/hands on skills lab training occurs in 69% of initial training sessions  12% require mentoring shifts  17% offer informal training  7% utilize bedside training methods

10. Education  Annual recertification - 43%  More frequent recertification occurs 26% smaller volume programs  19% of programs have no formal annual competency or recertification programs  Many centers education programs are under review

11. Equipment

12. Equipment and Supplies  Solutions Custom made - 36% Normocarb - 31% Remaining centers used a combination of normocarb and custom or prismanate  Med-comp is the catheter of choice in 45% of programs

13. Anticoagulation  40% utilize citrate  13 of 16 centers have converted from heparin to citrate within the last 2 years  Centers using both change depending on patient needs

14. What does all of this tell us?  Variable approaches to therapy, training, methods, equipment and supplies  National certification programs help with consistency in training  PCRRT Registry potential to help standardize management develop protocols review outcomes