Continuous Renal Replacement Therapy (CRRT): What Nurses Need to Know
Description
Continuous Renal Replacement Therapy (CRRT) is an important part of critical care nephrology. People with acute kidney injury (AKI) who are hemodynamically unstable benefit from it. As the first people who help patients in intensive care units (ICUs), nurses are responsible for making sure that CRRT is given safely, closely watched, and fixed before problems happen. This complete guide goes into detail about the most important parts of CRRT that every nurse needs to know to make sure patients get excellent care that is also safe.
What is CRRT, or Continuous Renal Replacement Therapy?
CRRT is a slow, continuous extracorporeal blood purification treatment that is mostly used on very sick people whose kidneys aren’t working well. CRRT runs 24 hours a day, unlike intermittent hemodialysis (IHD), which only works for three to four hours at a time. This type of treatment makes it possible to remove solutes and fluids more gently without causing sudden changes in blood flow.
CRRT should be used for
Heavy fluid overload
Damage to the kidneys quickly
Unbalanced acids and bases and electrolytes
Sepsis with problems with the kidneys
Several organs fail
Different kinds of CRRT and how they are used in medicine
There are four main types of CRRT, and each one removes solutes and fluids in a different way:
1. CVVH stands for continuous veno-venous hemofiltration.
By filtering plasma water through a semipermeable barrier, CVVH gets rid of solutes through convection. To keep the volume balanced, a substitute fluid is added.
2. Hemodialysis that runs all the time (CVVHD)
CVVHD uses diffusion, in which solutes move quietly across a concentration gradient into a dialysate solution that flows against the blood flow.
3. CVVHDF stands for continuous venous-venous hemodiafiltration.
It is the most effective way to get rid of both small and middle molecular weight solutes because it uses both convection and diffusion.
4. SCUF stands for Slow Continuous Ultrafiltration.
Only those with stable metabolic parameters and excessive fullness can benefit from SCUF.
What nurses need to do to manage a CRRT
Setting up and priming the CRRT machine
Check that the machine (like a Prismaflex or Aquarius) is set up correctly.
To avoid an air embolism, make sure that all of the tubing is primed with clean fluid.
Make sure you comprehend the recommended CRRT modality, flow rates, and replacement/dialysate fluids before beginning therapy.
Management of Catheters and Access Sites
Use only double-lumen venous tubes specifically designed for that purpose. These are usually put in the femoral, jugular, or subclavian veins.
To lower the risk of getting an illness, use strict aseptic techniques when caring for a catheter.
Check the insertion spot often for signs of infection, bleeding, or movement.
Keeping an eye on and changing therapy parameters
Watch the machine to see the artery, venous, transmembrane (TMP), and return line pressures in real time.
Check the patient’s vital signs every hour to make sure their blood flow is stable.
Track your fluid intake and output, including ultrafiltration volume and net balance.
Check for signs of bleeding in the circuit, such as visible fibrin, rising pressures, or changes in the color of the blood.
Taking care of electrolytes, fluids, and the acid-base balance
Every 4 to 6 hours, nurses must carefully check electrolyte panels and arterial blood gases (ABGs):
Change the dialysate’s composition if there is hypokalemia or hyperkalemia.
It’s important to keep calcium and bicarbonate levels steady, especially when citrate anticoagulation is used.
Change how quickly fluid is being removed based on urine flow, central venous pressure (CVP), and mean arterial pressure (MAP).
Blood clotting in CRRT
1. Systemic Heparin
People often use it due to its ease of administration.
Monitor the aPTT readings and any indications of bleeding.
2. Citrate anticoagulation in the region
It provides a longer circuit life and reduces the risk of bleeding.
You must closely monitor the ionized calcium levels throughout the system and after the filter.
The nurses must adjust the calcium replacement injection as needed.
If you don’t handle anticoagulation properly, the circuit can clot too soon, therapy can be interrupted, and patients can have problems.
Problems that often happen with CRRT and what nurses can do to help
Circuit Clotting: Make sure there is enough heparin.
Keep blood flow delays to a minimum.
Follow the instructions and flush the catheter openings regularly.
Low blood pressure
Watch the patient’s blood pressure and heart rate as the treatment starts and is adjusted.
If necessary, slow down the ultrafiltration rate or stop treatment for a short time.
An imbalance of electrolytes
If the patient shows signs of dizziness, seizures, irregular heartbeats, or muscle weakness, the labs should be checked again.
Work with the intensivist or nephrologist to fix the electrolytes.
Getting sick
Put in place strict steps to stop infections.
Monitor the temperature, the quantity of white blood cells, and the stability of the access site.
Important Paperwork for CRRT
The paperwork includes charts that show the machine pressures, filter state, and alarms every hour.
Keep track of all the fluids that go in and out, including the ultrafiltrate amount.
Keep records of test results and changes to electrolytes and medications.
Record any bad things that happen, any changes to the circuit, and how the patient reacts to treatment.
Not only does accurate documentation support medical-legal and billing needs, but it also guarantees quality care.
Thoughts on Medication CRRT can change the pharmacokinetics of a number of drugs, including
Drugs that kill germs, like vancomycin and aminoglycosides
Painkillers and sedatives
Epilepsy drugs
The nurses need to check with the doctor to see if dose changes are needed based on the type of CRRT and the rate of clearance.
What ICU nurses need to learn and be trained for
To give the best care during CRRT, ICU nurses should do the following:
Finish the official CRRT training and exercises.
Keep up with the latest medical rules and machine instructions.
Take part in multidisciplinary rounds to stay on track with changing treatment goals.
Nurses stay skilled, sure of themselves, and able to handle difficult CRRT situations by continuing their education.
In conclusion
Continuous Renal Replacement Therapy is more than just a technical process in the intensive care unit, where lives are at risk. Nurses play a multifaceted part in managing CRRT, which includes understanding technology, physiology, drugs, and people. Knowing the basics of CRRT and being proactive about checking on patients are two things that nurses can do to save lives with accuracy and trust.