Continuous Renal Replacement Therapy (CRRT) practices in Canadian hospitals: Where are we now?

BACKGROUND: Acute kidney injury (AKI) is a common complication in critically ill patients. Renal replacement therapy is prescribed for as many as 70% of critically ill patients in AKI and may be provided in the form of intermittent or continuous dialysis including intermittent hemodialysis, sustained low-efficiency dialysis, and continuous renal replacement therapy (CR RT). CRRT is commonly used for unstable critically ill patients, as it involves a slow continuous process. The nursing work involved with CR RT is highly complex and the learning requirements are challenging; therefore, it is important to identify nursing practices. PURPOSE: A national survey was conducted to gain insight into CRRT nursing practices. METHODS: T he design for this study was descriptive using a survey The target population for this survey was ICU nurse educators at Canadian teaching and community hospitals. Topics in the survey included staff education, CRRT ordering and initiation practices, vascular access, filters and filter life, fluids used, anticoagulation methods, adverse events, and greatest concerns. FINDINGS: One hundred and twenty-nine surveys were sent out and 73 were returned for a response rate of 57%. Thirty-six hospitals used CRRT and of these, 73% had used CR RT for more than eight years. The findings revealed that educators identified achieving and maintaining competence as their greatest concern related to CRRT practices. CONCLUSION: The fndings of this research revealed that consistent training programs were not the norm. The complexity of caring for patients on CRRT requires consideration of when to introduce to staff the technology and care of patients on CRRT and how to sustain their competence.

Exploring CRRT practices in ICU: a survey of Canadian hospitals.

BACKGROUND: Continuous renal replacement therapy (CRRT) is a highly specialized therapy not only for patients with acute renal failure, but also for patients with other critical conditions. The nursing work involved in CRRT is complex and the learning requirements are challenging to sustain ongoing competence. There are also adverse events associated with CRRT, such as those resulting from the anticoagulation therapy. Limited nursing literature is available regarding the use of CRRT by nurses in Canadian intensive care units. METHODS: In 2005, the authors conducted a national survey of CRRT nursing practices with nurse educators in intensive care units. The survey had fixed choice, as well as open-ended questions exploring various aspects of CRRT implementation, including education provided and adverse events experienced by patients. RESULTS: Of the 53 teaching and non-teaching hospitals that were sent the survey, 50 replied (94% response rate). Thirty-four of the sites used CRRT. The results reported here represent the findings from the survey questions pertaining to education and adverse events only. CONCLUSION: The results indicate that education, continuing competence, and prevention and management of adverse events, such as bleeding and filter clotting, are the major issues related to CRRT nursing practice across Canada.