CRRT | Continuous Renal Replacement Therapy
This week I learned about CRRT with two different patients. I’m definitely still learning, but I feel that I’ve gotten a good handle on it so far for only having two patients. In both of these cases, the reason CRRT, or continuous renal replacement therapy, was chosen over dialysis was due to hypotension.
In the previous week, I had a patient who was receiving dialysis and was almost switched to CRRT because of his blood pressure, which was luckily able to be brought up with levo.
Purpose of CRRT
Like dialysis, the goal of CRRT is to remove toxic waste from the patient as well as any excess fluid from the body. CRRT is used in patients who have acute or chronic renal failure and cannot hemodynamically handle traditional dialysis.
The machine itself is a little intimidating, and then you see the disposable filter and wonder how on earth you are supposed to get this machine to function. Surprisingly, the machine prompts you through the set up very very well. I’ve now gotten the chance to go through the set up portion 3 times and I found that it does get easier each set up. You spend a little less time comparing the screen prompts over and over to what you’re doing. This machine uses 2L of saline to prime the filter and tubing prior to hooking it up to the patient’s temporary dialysis catheter.
At my hospital, a patient on CRRT earns you a 1:1 ratio. You have an hourly sheet that needs filled out with the levels of dialysate, blood removal, and more. This sheet helps you determine what the next hours blood removal should be, if removal has been ordered. The numbers on this sheet gets entered into the patients chart. So far, I do enjoy taking care of a CRRT patient because of the 1:1, the higher level of acuity, and I do enjoy filling out the worksheet and getting to do a little math.
Urgent CRRT
Since starting this post, I ended up getting a patient in severe rhabdomyolysis. After getting the patient (somewhat) stabilized the intensivist wanted to start CRRT as soon as possible. We worked quickly to get the room picked up from the mess we made while stabilizing the patient—between a shockable rhythm, blood transfusions, intubation, 2 temporary dialysis catheter insertions, 1 art line insertion, 9 primary lines running, plus many many med pushes we made quite the mess. In order to fit the CRRT machine into the room, we had to condense our IV pumps onto a larger set up. Once we got the CRRT machine in the room, I was able to set the machine up from start to finish without a hitch - I was happy to be able to work quickly to hopefully remove some of the waste in this patients blood, but I was also proud of myself for working quickly in such a tense situation.
CRRT Tips
I really only have one tip at this point, but it’s to use the blood warming tube! Half of the patients that I’ve taken care of on CRRT had a drop in temperature that was unreadable by axillary thermometer. After recognizing the temp was not taking, we applied a bair hugger, applied the warming tube (it literally looks like pipe insulation), and recheck again at the next hour. Now— if your patient has a fever, the blood warming tube probably isn’t necessary.
