Continuous Renal Replacement Therapy (CRRT) - Education for Bedside Critical Care Nurses by Ann M https://padlet.com/armadden02/s4u4eqdpx13jcfkf CRRT in critically ill patients has benefited from the use of information and communication technologies. With the understanding of this intervention and the technologies involved, the goal of this Padlet is to develop strategies to reduce risks, improve health outcomes and enhance accessibility of care to this population of critically ill patients. en-us 2023-07-01 00:50:30 UTC 2023-07-14 15:10:26 UTC hello@padlet.com https://www.baxter.com/sites/g/files/ebysai746/files/inline-images/PrisMax_CRRT%20Graphic.jpg What is CRRT? Why is it Used? armadden02 https://padlet.com/armadden02/s4u4eqdpx13jcfkf/wish/2636373866 CRRT is a continuous, 24 hour dialysis therapy that is used in the ICU setting commonly set up and run by the bedside nurse. It is a medical intervention to provide kidney support to hemodynamically unstable, critical patients who would not tolerate hemodialysis (HD). Similar to HD, CRRT acts as a renal replacement therapy. It has the potential to remove plasma water (fluid) and solutes (wastes) from a patient’s blood; however, with CRRT this is accomplished slowly. This is done with the attempt of decreasing fluid and electrolyte shifts  with the goal of maintaining a patient's hemodynamics. 

Examples of patients requiring this therapy are a diagnosis of a AKI (acute kidney injury), electrolyte dysfunction, sepsis, metabolic acidosis, fluid overload, heart failure, rhabdomyolysis, multisystem organ dysfunction and inflammatory disorders.   

The for-mentioned examples are the health related issues that have benefited from the use of  the intervention CRRT.]]> 2023-07-01 17:56:56 UTC https://padlet.com/armadden02/s4u4eqdpx13jcfkf/wish/2636373866 What Type of Technology and Equipment is Used with CRRT? armadden02 https://padlet.com/armadden02/s4u4eqdpx13jcfkf/wish/2636374853 The CRRT is performed with the use of a specialized technology referred to as a CRRT machine. This machine consists of a filtration component, fluid warmer, cartridge and cycler. An anticoagulation component may also plays a role in this process. 

The  cycler, AKA,  the blood purification machine is the operational unit of the system. This system utilizes pumps and sensors needed for the actual operation to be performed. The cycler, or hardware of this technology, is serviced by a brand specific representative independent to the hospital. This representative specializes in machine maintenance and  the cycler's software system updates.

 Independent to these methods a vascular access site is used to hook the patient up to the machine in order to initiate the process.  

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For this intervention to occur  there is a support staff fully involved with the communication surrounding these patients and their CRRT therapy.  This support staff refers to providers, pharmacists, nurses, dietary and the medical machine representatives. This communication technology involves the use of cortex (messaging between providers and nurses), faxing orders to pharmacy  (fluid solute bags are provided by pharmacy) and the continuous updates via phone. Face to face  communication with family regarding the patient’s prognosis and plan of care is always imperative in any healthcare setting. 

FUN FACT!!!!

There are four main methods of CRRT that are based on the critical care team and nephrologist orders.

  1. Continueous Venovenous Hemofiltration (CVVH)- 
  2. Continuous Venovenous Hemodialysis (CVVHD)-  
  3. Continuous Venovenous Hemodiafiltration (CVVHDF)
  4. Slow Continuous Ultrafiltration (SCUF)

 

]]> 2023-07-08 23:21:22 UTC https://padlet.com/armadden02/s4u4eqdpx13jcfkf/wish/2640942826 What is Cortext? armadden02 https://padlet.com/armadden02/s4u4eqdpx13jcfkf/wish/2640946182 2023-07-08 23:54:41 UTC https://padlet.com/armadden02/s4u4eqdpx13jcfkf/wish/2640946182 Baxter CRRT Machine armadden02 https://padlet.com/armadden02/s4u4eqdpx13jcfkf/wish/2640947499 Check out the  Manufacturer Baxter's Page with Information on their CRRT machine!! ]]> 2023-07-09 00:08:41 UTC https://padlet.com/armadden02/s4u4eqdpx13jcfkf/wish/2640947499 Medtronic CRRT Machine armadden02 https://padlet.com/armadden02/s4u4eqdpx13jcfkf/wish/2640948479 Check out the Medtronic's Page with Information on their CRRT Machine!!]]> 2023-07-09 00:16:05 UTC https://padlet.com/armadden02/s4u4eqdpx13jcfkf/wish/2640948479 Another Explanation of CRRT armadden02 https://padlet.com/armadden02/s4u4eqdpx13jcfkf/wish/2640954910 There are a lot great videos out there that explain this intervention. Check out this one from a YouTube Channel called ICU Advantage. ]]> 2023-07-09 01:14:01 UTC https://padlet.com/armadden02/s4u4eqdpx13jcfkf/wish/2640954910 What about CRRT? What does the data tell us? armadden02 https://padlet.com/armadden02/s4u4eqdpx13jcfkf/wish/2643708287 It is so important to review the literature on CRRT and educate ourselves on strategies on improving health outcomes and enhancing care. Very limited statistical data was provided through the CDC, Agency for Healthcare Research and Quality and NYS Health department, however, the significance for this intervention is demonstrated through the below statistics. These statistics were obtained through retrospective studies published over the past 3 years. The links to the studies are provided with the statistics below. This epidemiological data obtained can be analyzed in order to increase one’s education on this intervention as well as to provide strategies for these patients to improve health outcomes.


]]> 2023-07-12 17:52:01 UTC https://padlet.com/armadden02/s4u4eqdpx13jcfkf/wish/2643708287 armadden02 https://padlet.com/armadden02/s4u4eqdpx13jcfkf/wish/2643712698 Kim et al., (2023) found that:

Sustained VT occurrence after starting CRRT is associated with increased patient mortality. The monitoring of electrolytes and acid-base status during CRRT is essential because of its relationship with the risk of VT.

]]> 2023-07-12 18:04:57 UTC https://padlet.com/armadden02/s4u4eqdpx13jcfkf/wish/2643712698 armadden02 https://padlet.com/armadden02/s4u4eqdpx13jcfkf/wish/2643714073 Siddiqui et al., (2020) found that:

CRRT has become the choice of RRT for the treatment of AKI in patients admitted to ICUs. In this single-center retrospective review, the overall in-hospital mortality of patients undergoing CRRT in ICU was found to be 84.2%, with only 24.8% of patients surviving the 15-day post-CRRT mark. The reported mortality in patients undergoing CRRT in the ICU ranges from 37% to 75% .

]]> 2023-07-12 18:09:11 UTC https://padlet.com/armadden02/s4u4eqdpx13jcfkf/wish/2643714073 armadden02 https://padlet.com/armadden02/s4u4eqdpx13jcfkf/wish/2643715227 2023-07-12 18:13:38 UTC https://padlet.com/armadden02/s4u4eqdpx13jcfkf/wish/2643715227 armadden02 https://padlet.com/armadden02/s4u4eqdpx13jcfkf/wish/2643778321
Opgenorth et al, (2022) demonstrated that:


The factors predicting in-hospital mortality in critically ill patients who require CRRT have not been established. Critical care teams should be aware that certain risk factors should be considered in the triage of ICU patients receiving CRRT.

]]> 2023-07-12 21:34:28 UTC https://padlet.com/armadden02/s4u4eqdpx13jcfkf/wish/2643778321 armadden02 https://padlet.com/armadden02/s4u4eqdpx13jcfkf/wish/2644034155
- The implementation of CRRT on a standardized scale with a framework geared towards decreased mortality, length of stay and hospital cost. 

- The creation of a quality assurance program in order to support provisions made for CRRT in order to achieve a proper standardization scale.

- Standardized, routine lab value monitoring, specifically electrolytes and blood gases in order to decrease the risk of VT (ventricular tachycardia) or any other rhythms that could potentiate cardiac arrest.




]]> 2023-07-13 03:05:55 UTC https://padlet.com/armadden02/s4u4eqdpx13jcfkf/wish/2644034155 armadden02 https://padlet.com/armadden02/s4u4eqdpx13jcfkf/wish/2644389427  There is a very high risk of early mortality with an ICU admission and an AKI requiring CRRT. Although it is only provided to those critically ill, these statistics can help advise us just how ill a patient is and help to create additional strategies to improve their outcomes. ]]> 2023-07-13 11:44:34 UTC https://padlet.com/armadden02/s4u4eqdpx13jcfkf/wish/2644389427 armadden02 https://padlet.com/armadden02/s4u4eqdpx13jcfkf/wish/2644398546 2023-07-13 12:03:16 UTC https://padlet.com/armadden02/s4u4eqdpx13jcfkf/wish/2644398546 armadden02 https://padlet.com/armadden02/s4u4eqdpx13jcfkf/wish/2644543465 References:

AlEnezi, F., Alhazzani, W., Ma, J., Alanazi, S., Salib, M., Attia, M., Thabane, L., & Fox-Robichaud, A. (2014). Continuous venovenous hemofiltration versus continuous venovenous hemodiafiltration in critically ill patients: a retrospective cohort study from a Canadian tertiary center. Canadian respiratory journal, 21(3), 176–180. https://doi.org/10.1155/2014/965479

Continuous Renal Replacement Therapy (CRRT), Market Size, Share & Covid-19 Impact Analysis, By Product Type (Systems, and Consumables), By Modality (Slow continuous Ultra Filtration (SCUF), Continuous Venovenous Hemofiltration (CVVF), Continuous Venovenous Hemodialysis (CVVHD) and Continuous Venovenous Hemodiafiltration (CVVHDF), and Regional Forecast, 2020-2027.(2020).  Market Research Report. https://www.fortunebusinessinsights.com/continuous-renal-replacement-therapy-crrt-market-102547

Golper, T. T. (2021). Continuous kidney replacement therapy in acute kidney injury. UpToDate. Retrieved July 9, 2023.

Kim, S. G., Yun, D., Kim, J., Lee, J., Kang, M. W., Kim, Y. C., Kim, D. K., Oh, K. H., Joo, K. W., Koo, H., Kim, Y. S., & Han, S. S. (2023). Risk of ventricular tachycardia and its outcomes in patients undergoing continuous renal replacement therapy due to acute kidney injury. Kidney research and clinical practice, 42(3), 370–378. https://doi.org/10.23876/j.krcp.22.101

Opgenorth, D., Reil, E., Lau, V., Fraser, N., Zuege, D., Wang, X., Bagshaw, S. M., & Rewa, O. (2022). Improving the quality of the performance and delivery of continuous renal replacement therapy (CRRT) to critically ill patients across a healthcare system: QUALITY CRRT: a study protocol. BMJ open, 12(2), e054583. https://doi.org/10.1136/bmjopen-2021-054583

Ruiz, E. F., Ortiz-Soriano, V. M., Talbott, M., Klein, B. A., Thompson Bastin, M. L., Mayer, K. P., Price, E. B., Dorfman, R., Adams, B. N., Fryman, L., Neyra, J. A., & University of Kentucky CRRT Quality Assurance Group (2020). Development, implementation and outcomes of a quality assurance system for the provision of continuous renal replacement therapy in the intensive care unit. Scientific reports, 10(1), 20616. https://doi.org/10.1038/s41598-020-76785-w

Saunders, H. & Saghavi D.K. (2023). Continuous Renal Replacement Therapy. NIH National Library of Medicine StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK556028/

Siddiqui, A. H., Valecha, G., Modi, J., Saqib, A., Weerasinghe, C., Siddiqui, F., & El Sayegh, S. (2020). Predictors of 15-Day Survival for the Intensive Care Unit Patient on Continuous Renal Replacement Therapy: A Retrospective Analysis. Cureus, 12(5), e8175. 
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7237053/

Welbaum, C. (2021). Nurse’s role in continuous renal replacement therapy. American Nurse Official Journal. https://www.myamericannurse.com/crrt-nurses-role-in-continuous-renal-replacement-therapy/
]]> 2023-07-13 16:47:43 UTC https://padlet.com/armadden02/s4u4eqdpx13jcfkf/wish/2644543465 armadden02 https://padlet.com/armadden02/s4u4eqdpx13jcfkf/wish/2645163255 "The global continuous renal replacement therapy (CRRT) market size was valued at $986.4 Mn in 2019 & is projected to reach $1,811.5 Mn by 2027, at a CAGR of 8.0%."

This demonstrates the increase in this therapy throughout the years.

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