Pediatric CRRT:
The Dialysis-Centric Program
Helen Currier BSN, RN, CNN, CENP
Director, Renal & Pheresis Services
Texas Children’s Hospital
Houston, Texas
Did you know . . . .
Do what you do best….
everyone has different
strengths.
Getting Started
DME
• The Pediatric Ideal: CRRT Equipment
– Separate and accurate pumps and scales for each
component of CRRT
– Range of blood flows with a minimum of
20ml/min
– Thermoregulation
– Maximum safety features
Supplies
• The Pediatric Ideal: CRRT Circuit
– Minimum priming volume with low resistance
– Exchangeable components
– Biocompatible membrane
CRRT Product Line Management
• Financial Management
– Group Purchasing Organization (GPO)
– Expenses and Billing
– Vendor Contract Compliance
• Materials
– Supply Chain Management
• movement and storage of CRRT supplies, from point-oforigin to the bedside
– Workflow
– Inventory Control
Supply Chain Event Management
(SCEM)
• Know non-clinical events and
factors that might disrupt CRRT
– Distribution Network
• Number and location of suppliers,
production facilities, distribution
centers, warehouses and customers
– Distribution Strategy
• Centralized versus decentralized,
direct shipment, third party logistics.
– Information
• Share valuable information, including
demand signals, forecasts, inventory
and transportation
– Inventory Management
• Quantity and location of inventory
• Explore potential scenarios and
plan for solutions
Don’t lose your
.
edge . . .
Monitor for Achieving Therapy Goals
• Patient
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Fluid volume balance
Electrolyte balance
Acid/Base balance
Body temperature
Vascular access for CRRT
Anticoagulation
Nutritional management
• Device
– Blood flow rate
– CRRT solutions
– Prescribed CRRT Fluid flow
rates to evaluate adequacy
of clearance
– Machine circuit pressure
alarms
– Integrity of pump tubing
segments and/or integrity
of transducer or pressure
pods
– System to minimize
interruption of therapy
Partnership is not a four-letter word
CRRT Competency Management
1.
Organize your CRRT competency assessment
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2.
Understand JCAHO expectations
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3.
Validate clinical proficiency
Maintain a consistent CRRT validation system
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6.
Design a compliant, consistent, and effective competency assessment
program
Validate CRRT competency
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5.
National Patient Safety Goals
Develop your CRRT competency assessment program
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4.
Determine critical competencies to evaluate annually
Tie critical competencies to annual performance reviews
Ensure that clinical proficiency is assessed and validated in a consistent
manner with our easy to implement skill sheets
Keep up with new CRRT competencies
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Verify and document new—and existing—competencies, including those for
new equipment
Simulation
• The world is in crisis
and the need for
superheroes couldn’t be
greater . . . .
Nephrology Nurse
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How CRRT works
Reason for treatment
When and how to terminate treatment
Equipment operation
Most common alarms
When and how to reach the nephrology team
Fluid balance calculations
Assessment of clotting
How to adjust AP/VP limits, BFR, or UFR
How to verify dialysis fluid or replacement fluid and/or
rate changes
Bedside Nurse: Competencies
• Verbalize
– How CRRT works (fluid and solute balance, changes in nutrition
and medications)
– Reason for treatment
– When and how to terminate treatment
– How to troubleshoot alarms (AP, VP, blood leak, error codes, air
detector)
– When and how to recirculate the system
– How to care for catheter and catheter exit site
– When and how to contact nephrologist or nephrology nurse
– How to operate extracorporeal circuit warmer
Bedside Nurse: Competencies
• Demonstrate
– How to calculate fluid balance
– How to assess clotting in the system
– How to adjust AP and VP limits, BFR, UFR
– How to verify dialysis and replacement fluid
solution and rates
– Document continuing care in nursing notes and
flow sheet
Safety Culture: Becoming a
Communication Superhero
• Teamwork across
hospital units
– Cooperation
– Coordination
• Handoffs and
transitions
– Transferring patients
from one unit to another
– Shift changes
Staffing Nurses for CRRT
• Variations
– Skill mix
– Opened vs. Closed
– Responsibilities
• Dialysis
• Critical Care
• Predictions
– FTEs by shift
– Budgeting FTEs
• Shortages
• Effects
– Clinical Outcomes
– Therapy Choice