Nurse Responsibilities & Clinical Decision Making When Caring for Critically Ill Pediatric Patients...
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![Page 1: Nurse Responsibilities & Clinical Decision Making When Caring for Critically Ill Pediatric Patients Requiring Continuous Renal Replacement Therapy Colleene.](https://reader035.fdocuments.in/reader035/viewer/2022070415/56649cf75503460f949c7897/html5/thumbnails/1.jpg)
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
![Page 2: Nurse Responsibilities & Clinical Decision Making When Caring for Critically Ill Pediatric Patients Requiring Continuous Renal Replacement Therapy Colleene.](https://reader035.fdocuments.in/reader035/viewer/2022070415/56649cf75503460f949c7897/html5/thumbnails/2.jpg)
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
![Page 3: Nurse Responsibilities & Clinical Decision Making When Caring for Critically Ill Pediatric Patients Requiring Continuous Renal Replacement Therapy Colleene.](https://reader035.fdocuments.in/reader035/viewer/2022070415/56649cf75503460f949c7897/html5/thumbnails/3.jpg)
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
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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
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• 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
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Childrens Hospital Los Angeles Hemofiltration Order Sheets
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![Page 9: Nurse Responsibilities & Clinical Decision Making When Caring for Critically Ill Pediatric Patients Requiring Continuous Renal Replacement Therapy Colleene.](https://reader035.fdocuments.in/reader035/viewer/2022070415/56649cf75503460f949c7897/html5/thumbnails/9.jpg)
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Hemofiltration
infusions, settings,
volumes & net hourly
fluid balance are
documented in the
electronic patient
record
![Page 11: Nurse Responsibilities & Clinical Decision Making When Caring for Critically Ill Pediatric Patients Requiring Continuous Renal Replacement Therapy Colleene.](https://reader035.fdocuments.in/reader035/viewer/2022070415/56649cf75503460f949c7897/html5/thumbnails/11.jpg)
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
![Page 12: Nurse Responsibilities & Clinical Decision Making When Caring for Critically Ill Pediatric Patients Requiring Continuous Renal Replacement Therapy Colleene.](https://reader035.fdocuments.in/reader035/viewer/2022070415/56649cf75503460f949c7897/html5/thumbnails/12.jpg)
• 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
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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
Thank You!