Lessons Learned and Pearls of CRRT Therapy - CRRT Explained!
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- čas přidán 24. 07. 2024
- In this sixth lesson in the CRRT Explained series, we are going to discuss many different, random, pearls of knowledge related to running CRRT therapy. These are all things that I have learned over the years, either through my own hard experiences, or through being taught by others that came before me. My goal is to be able to pass some of these along to you guys that you can use moving forward in the care of your own CRRT patients.
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0:00 Intro
1:15 Access/Return Issues
3:35 Clotting vs Cloggin
5:51 Prescribed vs Delivered Dose
7:25 Blood Return
8:42 Pre-priming
9:09 Fluid Balance
11:30 Crashing Patient/Codes
12:21 Citrate Anticoagulation
13:32 Remaining Pearls
15:44 Conclusion
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Check out these other great lessons and series of lessons below!
✅ Hemodynamics: • Hemodynamic Principals
✅ Shock: • Shock
✅ ECG/EKG Rhythm Interpretation: • ECG/EKG Interpretation
✅ ICU Drips: • ICU Drips
✅ ECMO: • ECMO
✅ CRRT: • CRRT Explained!
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#ICUAdvantage #CRRT #Nursing
I'm an acute dialysis nurse, I am loving seeing this. I will be checking out your other videos.
Thank you for all you do, so informative and helpful!!!
Thank you so much Melissa. It's great to hear that these videos are helpful to others. I'm so glad that you like it!
Excellent lesson🥳Thanks a million, expecting more videos..
Thank you so much for summarised and explained all the key points !
Glad you liked them!
You did a great job. Thank you - from a British ITU nurse from London.
Preparing to take my first CRRT patient soon. Thanks for all of the tips!
Super exciting Hannah! Always so cool to grow your knowledge and skillset in the ICU. I always loved that feeling of being able to do something new. Hope the tips help! 😊
Love this series of CRRT ❤️
Yay! So glad to hear you liked it. I hope I was able to cover a wide variety of good info in the series for ya.
thank you so so much. your work is appreciated!
I love your videos! Thank you
Hi Eddie. Greeting from Guyana.
Thanks for sharing your knowledge, CRRT is new to me but your discussion made simple.
Will be introducing CRRT soon.
Olive
Thank you so much. Nice refresher course!
Awesome! You're very welcome!
Thank you for this informative presentation sir.please continue what you are doing.
You are very welcome! I will definitely be doing so! 😊
Great lecture, was very helpful. Thanks for sharing your knowledge.
Glad you liked it Bernadit!
Thank you so much! Your videos are super helpful :)
Awesome! Thanks man
Thank you! These videos have been so helpful to me! Ugh those access issues...A while back my patient had such severe DIC they clotted off their freshly placed access within 15 minutes of starting crrt. Manually pulled a 3 inch clot out of the line when I disconnected to examine the line
Yikes! That is not a fun night right there. That’s never a good sign when they are clotting that bad. Just the other day we had a patient who was clotting in the syringe 💉 before we could even get blood out for the iStat!
very helpful, thanks for sharing.
Glad it was helpful Joyce!
This was excellent. Loved the whole series.
Very helpful, thanks
Thank you very much for the great videos
You re very welcome. Happy to help!
Loved this. Thanks. Pls upload for peritoneal dialysis too.
I have a nephrology exam in 2 days and I'm so grateful for this video
Glad to hear you liked it. You'll have to check back in and let me know how you did!
just wanted to say thanks for the videos..... Im a middle grade ICU doctor and learnt loads/ found it a super helpful video. Prescribe CRRT all the time and often have to help troubleshoot machines and found this video really helpful
Very cool! Glad you enjoyed the video and found it helpful. Hats off to you, as I've never had a doc help troubleshoot a machine :)
@ICU Advantage when I say trouble shoot... its often problems with access pressures/ line problems or high TMP's, short filter lifespans or issues with calcium comp... its a really good video series to get more insight what nursing staff are doing to manage these problems before and some of the other problems which you guys/ issues you guys are having running the machines
Your whole CRRT series of videos have been a great refresher and I'd highly recommend to anyone starting out in ICU in any roll or even as a refresher
Lol why was I hearing this lecture on my way to work and ended up getting my first CRRT patient lol 😂😂 thank you by the way! I've been hearing your lectures since nursing school 🙏🙏
Haha love it when the timing works out!
Hey Eddie. I’m a huge fan of your series. I was a bedside ICU nurse for years, left and am now working again. These videos are excellent for me to learn and refresh.
I do have a question. What is the “reaction” you reference from allowing a primed machine to sit for a while before beginning therapy? Is it a reaction with the fibers in the filter?
Thanks again.
I cant like these videos enough.
Hey Eddie, thank you so much for your videos! They have been extremely helpful to me over the past year as a new grad! I was wondering, with the experience you've had, are there a numbers for TMP and/or Pressure drop pressures where you would say it's time to return blood? For example, if your TMP is 300, would you just return the blood even if your filter is still running at that point? Safe before sorry type of thing. Hopefully, this makes sense. Thank you!
Can you make a video on explaining the order by the physician, the prescription, and possible recommends we would make under different circumstances or situations, and troubleshooting alarms that may be affected by the rates of the pumps
Hello! Can you explain the recipe to use in cvvhdf in postdilution for a 80 kg pacient? How we set the machine..see the machine request on the screen? thank you.Congrats!
I love your videos and their contents. I’m just wondering if you could make a video on CRRT calculations most especially on how to calculate for pre blood pump, dialysate and replacement flows ( ml/ hour). Thank you.
Glad you enjoy them. Thats really out of the scope of what bedside RNs do in the ICU so I probably won't cover that.
beautiful.
Could you do a series on IABPs?
It's on the todo list. Not sure when I'll get to it yet.
Tricks for high filter pressures? Is there anything but checking for kinks/obstructions that it may be and that you can try? What about access pressure? I usually turn the BFR up, is there anything else to do? Haven’t done CRRT in 15 yrs and we just started doing it at my facility. As ICU charge, I need to be a resource and I feel inadequate….
Hey Eddie. Great education on CRRT. I do have a question regarding when you spoke about priming the pump but the patient not available to be connected right away. What reaction could this potentially cause? and what causes it? Thank you :)
Hey, Eddie. First off, I recently got hooked on your videos and I find them both addicting and enjoyable. I'm a new ICU nurse with just over a year of experience. I recently finished a CRRT course through my hospital, however, due to COVID-19 the course was online, and the educational material was straight from Baxter. And, honestly, I felt like I didn't learn a lot other than the parts of the machine. I understand the renal system and the pathophysiology behind kidney disease, but I'm one who needs to see how the machine works in action. CRRT is straightforward, but I can't seem to fully grasp how to manage it yet. Can you make another CRRT video reflecting a mock case from initiation to discontinuation of therapy? I hope that makes sense...for example, you have a patient who's been in the ICU for about 2 weeks with trending kidney function markers for the past few days indicating renal failure warranting CRRT.
1. Setting up a new set into the machine after receiving CRRT orders from the nephrologist.
2. How to input those orders into the machine.
3. How to document hourly "Is" and "Os" when the patient is on various drips requiring frequent titrations.
4. How to troubleshoot the machine with common alarms that you've encountered in your experience running CRRT.
5. What to do with the machine when bathing the patient or transporting the patient to radiology for an MRI, CT, etc...
This isn't an exhaustive list, and please feel free to add on as much information you know would be pertinent to anyone new to managing CRRT.
Lastly, this is only a suggestion, and if you're too busy, I understand.
Wow, thank you so much Andrew for the great comment. I'm really happy to hear you are enjoying the videos on my channel. Sorry to hear that your CRRT course was sub optimal, but kudus to you for going out and trying to learn more on your own.
I may loop back around to the subject in the future as I have a LOT of other topics still on my todo list. The only potential issue that I see with your scenario and some of the asks to review is that some of it is very provider dependent. Both for initiation and recovery. There are some general topics and recommendations from Baxter and from the KDIGO guidelines that could be beneficial to discuss. I'll definitely add the suggestion to the todo list for future review. A couple of the points I think I did address in the final "CRRT Pearls" video, if you haven't checked that out yet. Certainly wasn't all inclusive, but some things that I've learned over the years.
Thanks for taking the time to leave a comment and a great suggestion. I appreciate you and wishing you all the best as you continue to grow in the ICU and grow your knowledge, especially with CRRT.
Yes, a short video on the alarms! I had my first CRRT yesterday (it was a chill CRRT, thank god)! That would be awesome! Maybe include things you’ve seen happen, like for instance, my blood separated in when I had my pt on his side while I changed several wound dressings, less than 8 minutes which apparently isn’t normal and I couldn’t return my blood.
As someone who does CRRT often this was a great series and everything you covered was pertinent! What are your thoughts/experience on what drips/medications can or can't be used during CRRT through the "nurse's port" line? I'd assume its "exit" is the most distal in the line. But this is something that seems to get mixed answers from different people. Thanks.
Glad to read this Matt. Sorry for the delayed response.
So, we try to avoid anything being infused through there. If anything, we will run bicarb. You are correct that it is the most distal port and "shouldn't" be taken up, but I think there is definitely mixed thoughts on that and we just try to avoid the potential risk.
We usually try to save that for an emergency line.
謝謝！
Thank you so much for this!
Can you do series on IABP?
Yes! I do have it on the todo list!
Hello, great video's! I have a question about why you shoudn't switch the lines (blue to red, red to bleu). I get that you when you swicht, the position of how the blood will get in or out of the patient changes but I don't understand why it would reduce the effeciency of the dialysis if the blood is returned proximally instead of distally.
Great question. Remember the blood is flowing proximal to distal in relation to the catheter. Therefore, if we are returning proximal, some portion of it will be flowing distally and be taken into the access port (now distally) and therefore we are running some portion of already treated blood back through the circuit, making it less efficient. Hope that makes sense!
Hi Eddie, firstly thanks for the great video. As a new ICU nurse I'm confused about when it's too late to return blood; You state 'before it completely clots' but Ive been told that it's already too late once the first 'filter is clotting' warning is shown as there is a risk of sending microemboli back to the patient. What do you think?
Great question David. So I wish there was a clear message on this but there's really not. The only thing Baxter talks about is stopping blood return with visible clots. When it comes to "Filter clotting" and "Filter clotted" warnings, no direction is given as far as I recall.
Remember that these warnings are based off rising pressures. Primarily pressure drop, but I do think they calculate TMP and return/access pressures in there somehow as well. That said, the "clotting" warning is as we approach limits, and "clotted" is once that is surpassed and sustained.
Where I have worked, the practice is to not return blood if "clotted" but not so for "clotting." That said, I'm not sure there is evidence that return of "clotted" filter blood is even harmful. Remember we are returning to venous circulation which means the lungs will serve as a trap for the clot. Large clots could obviously cause problems. But smaller ones, generally are less of a concern.
So then that leads into micro emboli. Sure, in disorders where the patient is showered with these, this can cause significant problem, but again I don't know if the evidence is there for some small portion of micro emboli even being returned with "clotting" or even "clotted" filters. And then if they are, again I don't think theres clear support for the negative effects of these.
Long winded, but at the end of the day, I'd 100% say to follow your hospitals policies and procedures as that's what protects you. In the absence of that, I think you need to evaluate what risks are being presented and try and make your own determination or rely on those experienced nurses and providers around you. Remember too that not returning the blood has consequences.
For the "safest" worry free approach, determine what your clotting limit alarm is set to and then monitor PD until approaching this limit and change filter before that limit is reached.
@@ICUAdvantage Thank you so much for such a fantastic reply with much more info than I could have hoped for. Perfect, I had seen many other nurses agency nurses return blood up until clotted warning but our own staff seem to err on the side of caution. Yes I will follow our hospital policy. Thanks again from over in Ireland!
My supervisor once said that before hemodialysis in ICU you need to prime the patient. What do they mean by that?
Sorry, I'm not real sure without context.
Hi Eddie, if a patient is scheduled for a surgery, is it necessary to stop the Heparin infusion via the CRRT circuit 4-6hrs prior to surgery? Some staff reckon it does not need to as the Heparin has little effects systematically. Thanks, really enjoy your lessons.
we don't use this in the ER but when we're holding ICU patients for days.....
Yikes! Not a good sign if they are holding for day! 😬
Can u do a video on calculations in CRRT?
What calculations are you looking for?
I talk about it in my other comment below.
@@tddaniels17 thanks
Need an actual video for full comprehension, otherwise all the info is based upon the assumption that people have previously had experience with the equipment.