Putting the 'C' Back into Continuous Renal Replacement Therapy

Headnote

Copyright 2013 American Nephrology Nurses' Association

Roeder, V.R., Atkins, H.N., Ryan, M.A., & Harms, H.J. (2013). Putting the 'C' back into continuous renal replacement therapy. Nephrology Nursing Journal, 40(6), 509-515.

It may seem obvious that continuous renal replacement therapy (CRRT) means that the treatment is truly continuous - administered without interruption on a 24/7 basis. In reality, a number of barriers limit the continuous aspect of CRRT. This article describes how nursing staffof an inpatient dialysis unit in a large Midwestern academic institution identified these barriers and developed and implemented a multifaceted plan to optimize CRRT.

Key Words: Continuous renal replacement therapy, CRRT, downtime, interruption, kidney dialysis.

Goal

To provide an overview of the barriers to providing optimal continuous renal replacement therapy (CRRT) and strategies to optimize CRRT outcomes.

Objectives

1. Explain the main advantage of continuous renal replacement therapy (CRRT).

2. Identify barriers to assuring that CRRT is continuous.

3. Discuss strategies to decrease the loss of time on CRRT.

Continuous renal replacement therapy (CRRT) is a standard mode of therapy for critically ill patients with acute renal insufficiency (ARI) (Heise, Gries, Moerer, Bleckmann, & Quintel, 2012; Kleger & Fässler, 2010; Prowle Schneider, & Bellomo, 2011). CRRT uses an extracorporeal circuit to ultrafilter plasma and remove water and wastes from a patient's blood. Its main advantage is that it provides renal replacement therapy in a slow, gentle, and continuous manner, re - sembling normal kidney function. CRRT is designed to run 24 hours a day. However, in reality, a number of barriers limit continuous therapy. Institutions providing CRRT for pa - tients with ARI need to answer two questions: 1) how continuous is the therapy being administered, and 2) if therapy is not continuous, what factors contribute to its interruption? This article describes our exploration of these questions and the methods we used to improve the practice and put the "C" back into CRRT.

Methods

Patients and Setting

The setting for this work was a 24/7 inpatient dialysis unit serving two hospitals associated with a large academic medical center in the Mid - west. This institution provides 1,800 patient-days of CRRT annually in 10 intensive care units (ICUs). Patients receiving CRRT range in age from 19 to 95 years.

Nephrology nurses who work...