Available 24 hours a day with minimal training.Training should be pretty extensive!
Hat tip: Anaesthesia-Intensive care
I loved doing CRRT while I was in the unit. Some ICU nurses love the ICU because of the adrenaline. I loved it for the multiple organ system failure, the very sickest of the sick. When we're still doin everything possible, and one system after another fails, dialysis becomes inevitable as do pressors. My unit's resource nurses knew I loved the 1:1 CRRT patients, so I got them often.
The Prisma measures pressures in several areas. It is very sensitive to changes in access pressures and return pressures. Therefore, if a patient is log rolled and the lines or catheter kink, the machine will stop and give an audible alarm. Most of the time this can be corrected by muting, identifying the problem and restarting the treatment.This advice applies to every CRRT device (Prismaflex, Edwards, etc.) on the market, not just the Prisma, and presumably every dialysis system as well. Even a shift in position can change the pressure, moving the patient's bed up and down can increase or decrease the pressures. The access pressure alarm is most likely to be caused by patient position (lines or cather kinking, blocked, pinched, etc.), then the return pressure alarm. The effluent and filter pressure alarms are not directly influenced by patient position, but can trigger because of the access or return pressure being too high or low due to patient position.
CRRT includes a variety of modalities that use ultrafiltration and may use convection, diffusion, or both. Treatment is 24 hours per day with a blood flow of 100-200 ml/min, and a dialysate flow of 17-34 ml/min in the case of diffusive technologies. The advantages of CRRT stem from its continuous nature: both fluid and solutes shift more slowly, allowing for better hemodynamic stability and more precise solute concentrationcontrol. The gradual nature of solute removal in CRRT makes it less likely to cause cerebral edema.19 In addition, CRRT has greater cumulative solute removal than IHD due to the longer treatment time.(although I've seen other blood and dialysate flow rates commonly used) And the reasons to use CRRT over intermittent hemodialysis (IHD):
Overall, these studies suggest a lack of survival improvement with CRRT versus IHD, with a possibility of improvement with CRRT in the most severely ill ARF patients. While studies have failed to show a survival advantage for any of the modalities, there are specific conditions where a particular RRT method is preferred over another. CRRT is recommended in patients with cerebral edema or liver failure, while IHD is more appropriate in patients with an increased risk of bleeding and life-threatening hyperkalemia.Although a bit dated, the article is a great resource if you want an overview of ARF treatments, including CRRT.
Andreas Link, Matthias Girndt, Simina Selejan, Ranja Rbah and Michael Bohm
Critical Care 2008, 12:R111
Approximately one third of all patients with cardiogenic shock suffer from acute kidney injury. Percutaneous coronary intervention (PCI), intra-aortic balloon counterpulsation (IABP) and continuous renal replacement therapy (CRRT) require effective antiplatelet therapy and anticoagulation resulting in a high risk for platelet loss and bleeding events. The reversible platelet glycoprotein (GP) IIb/IIIa receptor inhibitor tirofiban was investigated to preserve platelet number and activation in a prospective open-blinded endpoint evaluation study.Conclusions
This pilot study provides evidence that the use of tirofiban in addition to UFH prevents platelet loss and preserves platelet function in patients with cardiogenic shock and acute kidney injury requiring CRRT. The pathophysiological inhibition of platelet aggregation and platelet-monocyte interaction appears to be causally involved.