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
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
40
35
30
25
# Patients/yr
Median LOS
# Survived
20
15
10
5
0
2005
2006
2007
2008
2009
• 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
Hemofiltration used commonly as adjunct therapy with ECMO
ECMO trained nurses are
required to maintain
competency to manage
hemofiltration pump
PICU nurses also manage
CTICU hemofiltration
• Hemofiltration may be continued
when patients require surgery
• Your Text here
• 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
Thank You!
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 90027 USA
+1 (323) 361-2584
Lcyoung@chla.usc.edu