could you imagine being on continuous dialysis for 24 plus hours stay tuned for crt must knows [Music] hi guys welcome back to the mama nurse channel where we discuss everything nursing motherhood and lifestyle i'm vanessa please subscribe to the channel and make sure you hit that notification bell so you can be notified every time i drop a new video make sure you guys check the description box i always have links for different tools that i use and different things that might be useful for you as a nurse or you as a mom so make sure you stop by the description box before you leave so crt is continuous renal replacement therapy it's something that we use often on our icu unit it is typically a one-on-one assignment because you're doing hourly eyes and o's hourly calculations and adjustments when it comes to your crt machine there is a class that is required of you to take prior to being able to manage or have a patient on crrt crt is a blood purification therapy that's used for patients who are experiencing an acute kidney injury during this therapy the patient's blood passes through a special filter that purify that removes fluid and uremic toxins and returns clean blood to the body so some of the advantages of crt as opposed to hemodialysis is crt is a continuous therapy so you will not be disconnected from the machine unless the filter is being changed with hemodialysis it's typically done every other day on schedules of either monday wednesday friday or tuesday thursday saturday they do adjust those schedules from time to time and once you're starting out with hemodialysis typically you will have consecutive days of your treatment until they get your body in a better state and then they would switch to that scheduled dialysis so with crt you have greater hemodynamic stability there's avoidance of rapid fluid and electrolyte shifts and it is adapted to the needs of the critically ill hence why we use it in the icu so now we're getting into the must knows as a registered nurse working with a crt machine or a patient going through crt therapy there are certain things that you need to know i can't go through everything because it would be easier if i had the actual machine to show you some things but i'll give you a brief rundown of some things that will help you out in the future if you need to set up a crt machine so must know number one when you set up your machine for the initial setup you must set your date and time this is crucial when you are doing your hourly eyes and nose and your hourly patient history programming that comes it will make more sense once you're working with the actual crt machine but you're doing this every hour and the hour that you pull up on your screen is the hour that you would document on your documentation for your records or the patient's records so you want these times to match up otherwise you're going to be looking at a screen that says 4 am but it's really 9 a.m and then you'll have to do those calculations every hour just makes things too confusing when you have all these other numbers that you're working with you want your times to be set and on point that way you don't have any confusion in the future must know number two you will need to document everything that goes into your patient and everything that comes out of your patient so this includes clearing out every iv pump which typically when patients are on crt they have at least 6 to 10 pumps iv pumps if not more you will need to clear out every pump every hour you need to check your foley or urine output typically the patient will have a digni shield or some type of rectal bag you will need to document that output if they have an og document that output as well any flushes that you put into the patient any saline flushes document that if you're removing blood if you're giving medications all of these amounts need to be documented accurately because this is going to help you figure out how much fluid you need to remove for the next hour so that kind of went into must know number three it's basically that you're doing your calculations every hour so you need to make sure that they are accurate because it does as correlate for how much fluid you need to remove from hour to hour must know number four you will need to prime your filter set prior to connecting your patient to the crt machine this is done using two liter bags of normal saline so make sure that you have those ready to go once you do your setup of the machine or if you're in the middle of a treatment and you need to switch out your filter so must know number five if your filter is clogging you can return your blood to your patient and then change out your filter if your filter is clotting then you must stop the treatment remove the setup and change out your filter without returning that blood back to the patient so this is crucial if your filter is clotting you don't know where these clots are how big they are how small they are so you do not want to return that blood back to the patient if there's just a clog then you can return the blood back to the patient now this does make a difference because obviously all of that blood that's in that filter set is going to be lost so your patient can now potentially be hemodynamically unstable you want to try to work ahead of the machine if you notice that your numbers are rising then you would want to adjust and switch out your filters because before it becomes a situation where you're racing against the clock so if you're a current nurse who works with a crt machine let me know down in the comments if you guys have it as a one-on-one assignment i have heard from different facilities that it is not a one-on-one assignment but at our facility it is which i'm thankful for because it is a lot of work you're doing a lot of calculations every hour you're changing out the dialysate bags every couple hours give or take just depending on how much fluid is removed from the patient you're switching out your waste bag at least every two hours plus you're managing all of your drips that the patient is on and making sure that the patient is stable so a lot of work goes into it the class that you have to take is at least four hours and you do have to make sure that you're competent in it it is scary at first but once you get your first crt patient and you get the flow of how to do your numbers and everything like that then it all just makes sense and it's much easier i do have a flow sheet that i use for my documentation when it comes to having crt patients that keeps me organized for my hourly eyes and nose and my hourly numbers for the crt machine so i hope this information was helpful for you guys hopefully it gave you some good tips on starting a crt machine and all of the must knows so until next time stay safe be well and live life