1. NURSING CHALLENGES IN CRRT Sue Taylor Nursing CRRT Lead

2. Background CRRT history  Total PICU admissions at KCH was 1273 over last 2 years.  Children’s Critical Care performed CVVH in 71 patients in the last 2 years ( 476 episodes)  Total CVVH bed days = 1643  Of these, 173 episodes were for Acute Liver Failure

3. Nursing expectations  Following the decision to perform CRRT bedside nurses are responsible for the setting up and priming of the CVVH machines  Ensuring the prescriptions are available and correct  Preparing and commencing of treatment  Performing bedside ACT and initiating intervention if required  Calculation of patients daily fluid requirements and adjustments.  Discontinuing treatment when indicated by physician

4. Training at King’s “How training on CRRT has evolved over the last few years at King’s”  2012-2013 - Didactic and interactive teaching sessions ½ day for all grades of staff  2013-2014 - Didactic and ½ Simulation training day for all grades of staff  2014-2015 – Simulation lead training day including extensive trouble shooting using previous Adverse incidents reported  Documentation of individuals skills in CRRT using competency framework records

5. Nursing ratios for CRRT PICS standards state;  Ventilated patients receiving CVVH = 1.5/1  Non ventilated patients receiving CVVH = 1/1(cubicle) 0.5/1 In reality;  Increased bed usage and staff shortages due to sickness/ maternity and vacancy are less flexible and therefore patients receiving CVVH do not always get the correct nursing ratio they deserve.

6. ?? Questions?