Continuous Renal Replacement Therapy (CRRT)

Techniques

There are two modes we routinely use when providing renal replacement therapy on the ACCU, CVVHF and CVVHDF. There are comprehensive guidelines for RRT and Vascath insertion available in the ACCU folder.  Please ensure you put the correct line in the correct vein.

Our default method for anticoagulation is Regional Citrate Anticoagulation.  Heparin and prostacyclin are also available.  The usual dose prescribed is 25 mL/kg/min.  There are special circumstances (e.g. severe metabolic acidosis and oligo/anuric rhabdomyolysis) where the dose for HF may be increased to 35 or 60mL/kg/min – this is a consultant only decision.  The machine does not allow pre-dilution in HDF.

We cannot provide RRT in the HDU beds but you should consider if the patient can be transferred to the Renal HDU (discuss with Team C consultant).

CRRT link nurses

Each of the ACCU nursing ‘lines’ has at least one specially trained CRRT link nurse.  Their role is to support their colleagues and you in providing CRRT.  They have received in depth training on CRRT theory, methodology and troubleshooting.  You can spot them from their imaginatively designed badges!