Nurse Responsibilities & Clinical Decision Making When Caring for

Critically Ill Pediatric Patients Requiring Continuous Renal

Replacement Therapy

Colleene Young RN, BSN, CCRNPICU Clinical Nurse IV

Childrens Hospital Los Angeles

Childrens Hospital Los Angeles 286-Bed tertiary care children’s hospital

Affiliated with University Southern California Keck School of Medicine (20 bed PICU; 15 bed CTICU; 40 bed NICU)

Hospital admissions annually >11,000

PICU admissions annually >1,100

Training, Competencies & Troubleshooting

• Training includes one day class & two precepted shifts

• All critical care fellows are required to attend hemofiltration class

• Annual skills lab; nurses & fellows attend

• Circuit changes & troubleshooting measures tracked

Patients/year, Length of Stay & Survival

0

5

10

15

20

25

30

35

40

2005 2006 2007 2008 2009

# Patients/yr

Median LOS

# Survived

• Nurses present in rounds, actively participates in plan of care

•Worksheet computes 24º total intake (infusions, meds & flushes)

• Net (-/+) fluid balance determined; hemoflitration flow rates adjusted

Childrens Hospital Los Angeles Hemofiltration Order Sheets

Hemofiltration

infusions, settings,

volumes & net hourly

fluid balance are

documented in the

electronic patient

record

ECMO trained nurses are required to maintain

competency to manage hemofiltration pump

PICU nurses also manage

CTICU hemofiltration

Hemofiltration used commonly as adjunct therapy with ECMO

• Your Text here

• Hemofiltration may be continued when patients require surgery

• PICU nurses manage hemofiltration intra-operatively

• Study demonstrated benefit of CRRT during orthotopic liver transplantation

• Patients with hepatic disease at risk for acute kidney injury• Maintaining an even or negative fluid balance beneficial

Colleene Young RN, BSN, CCRNPICU Clinical Nurse IV

Childrens Hospital Los AngelesPediatric Intensive Care Unit4650 Sunset Blvd MS # 74

Los Angeles, CA 90027 USA+1 (323) 361-2584

Lcyoung@chla.usc.edu

Thank You!