【持续性肾脏替代治疗CRRT英文精品课件】Nursing Issues in Pediatric CRRT.pptVIP

Nursing Issues in Pediatric CRRT Helen Currier BSN, RN, CNN Assistant Director – Renal, Pheresis Scholar – Center for Clinical Research CRRT Treatment Responsibilities:Points to Remember Nephrology Nurse Initiate treatment based on individual patient needs as assessed by the nephrologist Bedside Nurse Do not infuse other medications or blood products directly into the CRRT system Cooling effects of CRRT may prevent temperature elevation Adjust patient fluid removal rate hourly to maintain net UFR Changes in net URF Before TreatmentEquipment/Supplies Nephrology Nurse Prisma/Prisma tubing Bedside Nurse Order dialysis fluid; citrate and any replacement solutions IV tubing for each infusion pump 3-way stopcocks Extracorporeal circuit warmer Extracorporeal circuit prime Telephone at bedside Before TreatmentEquipment/Supplies Nephrology Nurse Review and note CRRT orders Verify consent Notify bedside nurse of treatment orders and initiation time Set-up and prime CRRT circuit with heparinized normal saline Prime other lines in CRRT circuit Verify catheter placement Bedside Nurse Review, clarify, and note CRRT Draw baseline labs per CRRT orders Explain procedure and answer questions as needed Check cannulated limb for circulation Catheter Issues Design *largest diameter w/shortest length Diameter 19% ↑ = flow 2x 50% ↑ = flow 5x Increasing from 2.0mm to 2.1 mm increases flow 21% Length 19% ↑ in diameter will compensate for doubling of length Placement Site *RIJ (LIJ, IVC, Subclavian) Tip *well within the atrium Catheter Issues Catheter flow Early – malposition Kink Tip malposition – too high/low Tip malposition – arterial against the wall Tight suture Tip in wrong vessel Late – thrombosis or fibrin sheath formation Catheter Issues Catheter related infection Local Exit site – s/s redness, drainage, crusting, swelling, odor, or pain Tunnel – s/s swelling, pain, redness or ability to express draining down the tunnel track to the exit site Systemic Catheter related bact