Pediatric CRRT Programs: A tool-kit for evaluation

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Pediatric CRRT Programs A tool-kit for evaluation

• Helen Currier BSN, RN, CNN
• Assistant Director, Renal/Pheresis
• Texas Childrens Hospital
• Houston, Texas

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Patient care improves through a thorough product
evaluation.

• Formulate criteria and use these to comment
  critically
• The products impact
• The extent to which it meets a need
• Its purpose
• Resource limits

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Patient care improves through technology
and design.
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Size matters
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So why do users place a different value
on different products?

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The Pediatric Ideal CRRT Circuit

• Minimum priming volume with low resistance
• Exchangeable components
• Biocompatible membrane

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The Pediatric Ideal CRRT Equipment

• Separate and accurate pumps and scales for each
  component of CRRT
• Range of blood flows with a minimum of 20ml/min
• Thermoregulation
• MAXIMUM safety features

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The Pediatric Ideal CRRT Equipment

• Comes with a expert nurse!

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What are the competencies?

• How CRRT works (fluid and solute balance, changes
  in nutrition and medications)
• Reason for treatment
• When and how to terminate treatment
• How to troubleshoot alarms (AP, VP, blood leak,
  error codes, air detector)
• When and how to recirculate the system
• How to care for catheter and catheter exit site
• When and how to contact nephrologist or
  nephrology nurse
• How to operate extracorporeal circuit warmer

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More competencies

• Demonstrate
• How to calculate fluid balance
• How to assess clotting in the system
• How to adjust AP and VP limits, BFR, UFR
• How to verify dialysis and replacement fluid
  solution and rates
• Document continuing care in nursing notes and
  flow sheet

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Patient care improves through thorough product
evaluation.

• How is the product designed so that it is
  suitable for is suitable for a low-volume or
  high-volume pediatric program?
• What are the costs of the DME, disposables and
  associated labor (biomedical, nursing)?
• Are the supplies, tools and equipment specialized
  or general purpose?
• Who determines the quality of the finished
  product?
• How is the level of quality maintained?

t
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Definition of Healthcare Quality

• Quality of care is the degree to which health
  services for individual and populations increase
  the likelihood of desired outcomes and are
  consistent with current professional knowledge.

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Quality of care is the degree to which CRRT
services

• SCUF slow continuous ultrafiltration
• CAVH continuous arteriovenous hemofiltration
• CAVHD continuous arteriovenous hemodialysis
• CVVH continuous venovenous hemofiltration
• CVVHD continuous venovenous hemodialysis
• CVVHDF continuous venovenous hemodiafiltratio
  n

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For individual (pediatric patient) and
populations increases the likelihood of desired
outcomes

• Optimal clearance and ultrafiltration
• Safe extracorporeal volume
• Hemodynamic stablity
• Infection free
• Functional access
• Error free therapy

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And the care/outcomes are consistent with current
professional knowledge

• Professional guidelines (ADQI, Nephrology
  Nursing Standards and Guidelines)
• Science (ppCRRT)
• Recommendations

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Evidence Based Practice What is it?

• Activities that result in the best possible
  patient outcomes
• Practice based on research evidence is more
  likely to achieve quality patient outcomes

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Evidence based practiceHow do we know our care
is best practice?

• Accreditation - Establishes standards
• National Organizations (AACN, ANNA) - Promotes
  specialty
• Practice Acts - Protect the public
• Internal Policies - Guide practice
• Research - Provides evidence

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Standards Applications

• Quality Improvement systems
• Data bases
• Policies, procedures, protocols
• Position descriptions and performance appraisals
• Educational programs
• Staff training
• Patient education
• Regulatory systems
• Critical care and nephrology nursing research

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