Current State of Pediatric Continuous Renal Replacement Therapy PCRRT: A National Survey AJ Tanner,

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Current State of Pediatric Continuous Renal
Replacement Therapy (PCRRT) A National Survey
AJ Tanner, RN, BSN, ML Heard, RN, TL Young, RN,
BSN, SF Wagoner, MBA, RRT

• April J. Tanner, RN, BSN
• Advanced Technologies Coordinator
• Childrens Healthcare of Atlanta at Egleston

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A National Survey

• An national review of current trends in CRRT
• An 18 question survey sent to pediatric centers
  that offer CRRT
• free-standing or based in adult facility
• 42 centers responded

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Therapy Types
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Therapy Types

• 22 of 42 centers offer all available therapies
• Mean PCRRT pts per year 12.8 (1-60)
• Median pts per year 9
• 50 of centers have lt10 patients per year
• Average daily census of ICUs 13
• range of 5-27

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System Set-up
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Staffing Ratios
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Logistics and Coordination of System Set-up

• 11 of 42 centers have no formal 24/7 coverage
• In 93 of centers RNs manage the pump
• dialysis, ECMO, and physicians make up the other
  
• Charge structure
• the dept.that sets up equipment receives revenue
  in majority of centers
• 21 of 42 centers also have daily charges
• varied response as to where revenue goes

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Managing the Program
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Education

• Wide variety of teaching methods
• Didactic/hands on skills lab training occurs in
  69 of initial training sessions
• 12 require mentoring shifts
• 17 offer informal training
• 7 utilize bedside training methods

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Education

• Annual recertification - 43
• More frequent recertification occurs 26
• smaller volume programs
• 19 of programs have no formal annual competency
  or recertification programs
• Many centers education programs are under review

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Equipment
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Equipment and Supplies

• Solutions
• Custom made - 36
• Normocarb - 31
• Remaining centers used a combination of normocarb
  and custom or prismanate
• Med-comp is the catheter of choice in 45 of
  programs

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Anticoagulation

• 40 utilize citrate
• 13 of 16 centers have converted from heparin to
  citrate within the last 2 years
• Centers using both change depending on patient
  needs

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What does all of this tell us?

• Variable approaches to therapy, training,
  methods, equipment and supplies
• National certification programs
• help with consistency in training
• PCRRT Registry
• potential to help standardize management
• develop protocols
• review outcomes