Building a continuous renal replacement therapy program in a community hospital

www.nursingcriticalcare.com Acute kidney injury (AKI) occurs in approximately 20% of patients admitted to the ICU and is associated with increased morbidity and mortality.1,2 The prevalence of renal replacement therapy (RRT) for AKI is approximately 23%.2 RRT can be applied intermittently with intermittent hemodialysis, or continuously with continuous renal replacement therapy (CRRT). CRRT is the preferred mode of RRT in critically ill patients, especially in patients with hemodynamic instability.2,3 (See CRRT treatment modes.)4 Indications for CRRT include hyperkalemia, metabolic acidosis, fluid overload, and signs of uremia.2,5 CRRT removes metabolic waste, solutes, and excess fluid over a 24-hour period while the native kidneys recover. The patient’s healthcare provider orders the treatment mode, therapy fluid type, treatment intensity, and blood and ultrafiltrate rates based on the patient’s individualized needs.6 The nurse is responsible for acknowledging the CRRT order; gathering all supplies; setting up and discontinuing the dialysis circuit; monitoring lab values, acid-base imbalances, electrolyte replacement, hemodynamic parameters, and fluid balance; and titrating blood flow and ultrafiltrate rates as prescribed. Other nurse Abstract: Continuous renal replacement therapy (CRRT) is a high-risk therapy used to treat acute kidney injury. Community hospitals lack the patient volume to adequately develop staff CRRT competency. This article will cover lessons learned developing a CRRT program at a small community hospital with low patient census requiring CRRT.