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April J. Tanner, RN, BSN Advanced Technologies Coordinator Children’s Healthcare of Atlanta at Egleston PowerPoint PPT Presentation


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Current State of Pediatric Continuous Renal Replacement Therapy (PCRRT): A National Survey AJ Tanner, RN, BSN, ML Heard, RN, TL Young, RN, BSN, SF Wagoner, MBA, RRT. April J. Tanner, RN, BSN Advanced Technologies Coordinator Children’s Healthcare of Atlanta at Egleston. A National Survey.

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April J. Tanner, RN, BSN Advanced Technologies Coordinator Children’s Healthcare of Atlanta at Egleston

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Current State of Pediatric Continuous Renal Replacement Therapy (PCRRT): A National Survey AJ Tanner, RN, BSN, ML Heard, RN, TL Young, RN, BSN, SF Wagoner, MBA, RRT

April J. Tanner, RN, BSN

Advanced Technologies Coordinator

Children’s Healthcare of Atlanta at Egleston


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A National Survey

  • An national review of current trends in CRRT

  • An 18 question survey sent to pediatric centers that offer CRRT

    • free-standing or based in adult facility

  • 42 centers responded


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Therapy Types


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Therapy Types

  • 22 of 42 centers offer all available therapies

  • Mean PCRRT pts per year: 12.8 (1-60)

  • Median pts per year: 9

    • 50% of centers have <10 patients per year

  • Average daily census of ICU’s: 13

    • range of 5-27


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System Set-up


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Staffing Ratios


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Logistics and Coordination of System Set-up

  • 11 of 42 centers have no formal 24/7 coverage

  • In 93% of center’s RNs manage the pump

    • dialysis, ECMO, and physicians make up the other %

  • Charge structure

    • the dept.that sets up equipment receives revenue in majority of centers

    • 21 of 42 centers also have daily charges

      • varied response as to where revenue goes


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Managing the Program


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Education

  • Wide variety of teaching methods

  • Didactic/hands on skills lab training occurs in 69% of initial training sessions

  • 12% require mentoring shifts

  • 17% offer informal training

  • 7% utilize bedside training methods


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Education

  • Annual recertification - 43%

  • More frequent recertification occurs 26%

    • smaller volume programs

  • 19% of programs have no formal annual competency or recertification programs

  • Many centers education programs are under review


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Equipment


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Equipment and Supplies

  • Solutions

    • Custom made - 36%

    • Normocarb - 31%

    • Remaining centers used a combination of normocarb and custom or prismanate

  • Med-comp is the catheter of choice in 45% of programs


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Anticoagulation

  • 40% utilize citrate

  • 13 of 16 centers have converted from heparin to citrate within the last 2 years

  • Centers using both change depending on patient needs


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What does all of this tell us?

  • Variable approaches to therapy, training, methods, equipment and supplies

  • National certification programs

    • help with consistency in training

  • PCRRT Registry

    • potential to help standardize management

    • develop protocols

    • review outcomes


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