Overview
This video provides essential information and tips for nurses managing Continuous Renal Replacement Therapy (CRRT) in ICU settings, highlighting key must-knows in setup, monitoring, and documentation.
Introduction to CRRT
- CRRT is a continuous blood purification therapy used primarily for patients with acute kidney injury in critical care.
- Unlike intermittent hemodialysis, CRRT runs continuously and is typically managed as a one-on-one nursing assignment in the ICU.
- CRRT offers better hemodynamic stability and avoids rapid fluid/electrolyte shifts, making it suitable for critically ill patients.
Key Must-Knows for Nurses Managing CRRT
- Nurses must complete a special training class before managing CRRT patients.
- Initial CRRT machine setup requires accurate date and time input to ensure correct hourly documentation.
- All fluid intake and output—including every IV infusion, urine, rectal, gastric, and medication administration—must be documented hourly.
- Accurate, hourly calculation of fluid removal is essential to ongoing patient stability and management.
- The filter set must be primed with two-liter bags of normal saline before connecting to the patient or when replacing filters.
- If the filter clogs, blood can be safely returned to the patient before changing the filter; if the filter clots, treatment must stop and blood in the filter should not be returned due to clot risk.
- Anticipate rising filter pressures and change filters proactively to avoid emergent situations and potential blood loss.
Workflow and Best Practices
- CRRT cases involve frequent equipment management, including dialysate and waste bag changes every few hours.
- Managing CRRT patients requires frequent calculations, documentation, and multitasking with multiple infusion pumps and drips.
Training and Support
- Required CRRT training is at least four hours and ensures nurse competency before independent patient management.
- Organizational tools, such as documentation flow sheets, help nurses stay organized and efficient during CRRT management.
Recommendations / Advice
- Set up accurate machine date and time to align with documentation.
- Meticulously track every fluid input and output to calculate removal needs.
- Act early when filter pressures rise to minimize blood loss and hemodynamic instability.
- Utilize available resources, checklists, and workflow sheets to help maintain accuracy and organization during CRRT care.