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Pediatric CRRT: The Dialysis-Centric Program

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 .

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Pediatric CRRT: The Dialysis-Centric Program

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  1. Pediatric CRRT: The Dialysis-Centric Program Helen Currier BSN, RN, CNN, CENP Director, Renal & Pheresis Services Texas Children’s Hospital Houston, Texas

  2. Did you know . . . .

  3. Do what you do best…. everyone has different strengths.

  4. Getting Started

  5. 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

  6. Supplies • The Pediatric Ideal: CRRT Circuit • Minimum priming volume with low resistance • Exchangeable components • Biocompatible membrane

  7. 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-of-origin to the bedside • Workflow • Inventory Control

  8. 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 . . . .

  9. Monitor for Achieving Therapy Goals • Patient • 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

  10. Partnership is not a four-letter word

  11. CRRT Competency Management • Organize your CRRT competency assessment • Determine critical competencies to evaluate annually • Tie critical competencies to annual performance reviews • Understand JCAHO expectations • National Patient Safety Goals • Develop your CRRT competency assessment program • Design a compliant, consistent, and effective competency assessment program • Validate CRRT competency • Validate clinical proficiency • Maintain a consistent CRRT validation system • 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 • Verify and document new—and existing—competencies, including those for new equipment

  12. Simulation • The world is in crisis and the need for superheroes couldn’t be greater . . . .

  13. Nephrology Nurse • 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

  14. 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

  15. 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

  16. Safety Culture: Becoming a Communication Superhero • Teamwork across hospital units • Cooperation • Coordination • Handoffs and transitions • Transferring patients from one unit to another • Shift changes

  17. 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

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