ABSTRACT
Background: Of 800 patients treated annually in 19 ICU beds (catchment 500,000) 120 require renal replacement therapy (RRT) delivered by Baxter Prismaflex® (continuous veno-veno haemodiafiltration (CVVHDF)). With the onset of the COVID19 pandemic significant increased incidence of acute kidney injury (AKI) requiring RRT & existing intermittent haemodialysis (IHD) patients contracting COVID19 requiring ICU support raised concerns regarding RRT ICU capacity. Additionally a worrying national shortage of CVVHF/HDF consumables & new machines to deliver this requirement;all critical drivers to seek local solutions for RRT provision beyond usual capability Methods: A kidney unit neighbour described their successful experience trialling SC+ in home IHD patients. Translation of SC+ from home use to safe IHD treatment in ICU was quickly apparent alongside ease of supporting technical infrastructure set up & minimal training requirements. Immediate availability & fiscal acceptability of purchasing 4 Quanta SC+ and 2 supporting RO machines were critical determinants in making IHD a realistic & sustainable solution to desperate RRT shortages. Provision of expert technical support and clinical nurse specialist facilitation expedited training of ICU workforce & enabled swift implementation Results: 27 ICU nurses were trained in 3 weeks (23 in 14 days). Between 22/4/20 & 17/5/20 8 patients (range 37-63 yrs, median 53.5;7/8 known IHD, 1/8 AKI;7/8 COVID19 positive) received 20 treatments (1-5/patient) using SC+ in ICU. An agreed ICU IHD protocol was co-designed gaining consensus in an unfamiliar territory of provision of IHD in ICU & differing clinical perspectives in IHD prescription in a critical care setting Conclusions: At a time of unprecedented national shortage of dialysis machines & increased RRT need associated with COVID19, Quanta provided an effective solution for safe provision of IHD in ICU. Ease of use with training delivered in <6 hours enabled ICU nurses to effectively treat patients independent of dialysis nurses allowing continuity of the chronic HD programme. Learnings identified the importance of training, enabling rapid growth of a critical mass of expertise & confidence. Critical elements included mastering unfamiliar technique, establishing infrastructure, procurement & team communication enabled by online & face-to-face troubleshooting support.