Page 526 - ACCCN's Critical Care Nursing

Support of Renal Function 503

Learning activities
Learning activities 1–4 relate to the Case study. 3. Construct a simple dot-point checklist of the machine and RRT
1. Construct a database for your ICU to collect the filter ‘life’ for circuit before connecting to the patient. The list should be no
CRRT using a common spreadsheet program (e.g. Microsoft longer than one page and should include machine power,
Excel). Include in this database: tubing connections, fluid balance, anticoagulation and alarms.
● the RRT circuit start and stop time If such a list or check routine exists, does it need modifying or
● the reason the RRT failed or was stopped updating?
● effective use time before clotting or ceasing 4. All staff enjoy case presentations. Review a patient throughout
● the type and dose of anticoagulation used his/her illness when treated with RRT, and construct a case
● the patient’s daily clotting results presentation. Even if the case is routine, it may be useful to
● the daily urea and creatinine results. compare and contrast with a problematic case. Include in the
From this database, determine the mean, median and range of case: medical history, diagnosis and ARF presentation, bio-
filter life. This is an important measure, as the median value is less chemistry and diagnostic test results. Include initiation of RRT,
influenced by outliers or data that are well outside the ‘average’.
The ‘mean’ filter life may be changed significantly if one filter life solute levels, effective treatment time, problems, successes
was 100 hours when most of them were 22 hours, for example. and outcomes. What could be improved for another patient
Relationships or correlations can then be made between filter life treatment?
and anticoagulation used and clotting indices. In addition, it is 5. Create a learning resource for staff caring for a patient during
possible to determine the time spent off the CRRT, and this can be
a measure of nursing expertise resetting the circuit and/or reflect RRT, for example, a ‘tips and tricks’ list to aid new users and also
delays when medical staff need to attend to the patient before the to ensure efficiency and safety. What are the most common
new circuit can begin. problems or errors when using your RRT in the ICU? List these
2. Compare data from two facilities that use a different method and devise a guide for their prevention and/or remedy.
or machine (e.g. anticoagulation). Locate a friend or colleague
from a different ICU, collect data and then compare.

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