Skill:
Area of Practice:
Module and Status:
Level:
Author/date of origin:
Author/date of review:
Time estimate:
Management of patient receiving renal replacement therapy
General Intensive Care
Intensive Care End Module – NH3125
3
Jane Lovegrove
Intensive Care Management Team – July 2004
Knowledge required related to skill (should
know):
 Discuss the process of filtration in a
haemofiltration filter
 Explain the difference between the modes of
haemofiltration SCUF, CVVH, CVVHD,
CVVHDF and critically discuss where the use of
each may be indicated.
 Discuss the rationale/indications for changing
the treatment mode during therapy.
 Discuss the potential complications of renal
replacement therapy their causes and how
these can be recognised and/or minimized.
 Discuss the principles of setting up renal
replacement therapy, including settings for
exchange rates and fluid removal.
 Citing rationale for action, identify appropriate
preparation for a patient prior to renal
replacement therapy.
 Explain what is meant by pre and post dilution
and discuss situations where pre-dilution or
post-dilution may be considered.
 Explain what is meant by filtration fraction.
 Citing rationale for action identify the care and
management of a patient receiving renal
replacement therapy.
 Discuss the use of anticoagulant therapy in
RRT and types of anti-coagulation available.
 Identify the process of discontinuation of renal
replacement therapy and how this may be
managed (including care of VAS cath).
 Discuss how haemofiltration may influence
serum drug levels.
 Discuss the use of lactate free replacement
fluid.
 State when buffer solutions may be required
during renal replacement therapy.
 Discuss the affect of changing exchange
volumes
 State indications for changing therapeutic
mode.
 Answer questions regarding trouble shooting
problems associated with renal replacement
therapy.
 Discuss current developments in
haemofiltration.
Practice descriptor, i.e. can demonstrate skill
used stating knowledge base and act
appropriately at this level:
 Identifies the need for RRT and explains
procedure to patient/family
 Accurately assesses fluid balance of patient,
selects exchange rate and fluid removal and
anticoagulant according to prescription
 Prepares patient access and attaches renal
replacement therapy circuit to patient, securing
lines.
 Starts haemofiltration monitoring and
documents vital signs and filter pressures
accurately
 Monitors patients’ co-agulation status