Page 522 - ACCCN's Critical Care Nursing

Support of Renal Function 499

TABLE 18.7 Machine design and build approaches

Machine type Waste collection Membrane Circuit Pressure measurement Priming preparation
A One 5 L bag, empty AN69, prefitted, not Cartridge kit-based, In-line pressure Fully automated
when full, change changeable multipurpose; all transducers
bag modes
B 1–4 bags or 20 L Infomed Membrane Single tubing Isolated sideline air Semiautomated
bottle with pump not fitted, option components interface transducers
to drain direct: no for other partly assembled,
waste handling membranes mode specific

FIGURE 18.18 The Prismaflex CRRT machine (Hospal, Lyon, France).

100
their technical characteristics. Table 18.7 outlines the
major differences in machines or system approaches. Two
machines adopting common design features from Table FIGURE 18.19 The Infomed HF 440 CRRT machine (Infomed, Geneva,
18.7 are shown in Figures 18.18 (Prismaflex; Hospal, Switzerland).
Lyon, France) and 18.19 (Infomed HF 440; Infomed,
Geneva, Switzerland), each highlighting the major tech- often used. This was an adaptive technology and
42
nical differences in how CRRT machines are presented required a very manual, idiosyncratic approach. These
and used. days, with automated technology and on-screen prompts
and sequential step-by-step diagrams on machine screen
NURSING PRACTICE displays, such policies are not required, and the key head-
Key nursing management themes found in the literature ings in Table 18.8 along with the key nursing themes
useful for application of CRRT are: education and train- above, are a roadmap for protocol development. Table
ing; 42,101,102 methods for fluids management and fluid 18.8 also provides a brief problem and intervention-
92
balance; 103,104 anticoagulation approaches; and machines based review of nursing management for CRRT. For each
used. 99,100,105 Nursing protocols developed in the early group of nursing interventions, a practice recommenda-
1980s focused on how to prepare and prime a CRRT tion is included. These recommendations could be the
system, as modified dialysis pumps with IV pumps were framework for a nursing standard or policy for CRRT. A