CVVHD is the standard mode of CRRT on the RLH ACCU though there are occasions where CVVHF may be beneficial and these are clear in the comprehensive guidelines which can be found in box.
Regional citrate infusion is our first line anticoagulation, but heparin (or none) can also be used, again see the guideline to help in decision making.
The RLH takes a more novel approach to dosing CRRT which is based on the patient’s biochemistry allowing a more dynamic prescription rather than a fixed mLs/kg/hr regimen. There are occasions when bespoke prescriptions are needed (extreme sodium levels, severe intractable metabolic derangement, removal of a specific toxin) so do not be afraid to discuss with a consultant or one of the renal link nurses who have a more advanced knowledge of CRRT and can be recognised by the small yellow kidney badge they wear!
We currently do not routinely offer CRRT in the level 2 beds but patients may be able to have intermittent haemodialysis on the renal unit (or renal HDU) if its clinically appropriate.
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!