【持续性肾脏替代治疗crrt英文精品课件】nursing issues in pediatric crrt

《【持续性肾脏替代治疗crrt英文精品课件】nursing issues in pediatric crrt》由会员上传分享，免费在线阅读，更多相关内容在教育资源-天天文库。

1、NursingIssuesinPediatricCRRTHelenCurrierBSN,RN,CNNAssistantDirector–Renal,PheresisScholar–CenterforClinicalResearchCRRTTreatmentResponsibilities:PointstoRememberNephrologyNurseInitiatetreatmentbasedonindividualpatientneedsasassessedbythenephrologistBedsideNur

2、seDonotinfuseothermedicationsorbloodproductsdirectlyintotheCRRTsystemCoolingeffectsofCRRTmaypreventtemperatureelevationAdjustpatientfluidremovalratehourlytomaintainnetUFRChangesinnetURFBeforeTreatmentEquipment/SuppliesNephrologyNursePrisma/PrismatubingBedside

3、NurseOrderdialysisfluid;citrateandanyreplacementsolutionsIVtubingforeachinfusionpump3-waystopcocksExtracorporealcircuitwarmerExtracorporealcircuitprimeTelephoneatbedsideBeforeTreatmentEquipment/SuppliesNephrologyNurseReviewandnoteCRRTordersVerifyconsentNotify

4、bedsidenurseoftreatmentordersandinitiationtimeSet-upandprimeCRRTcircuitwithheparinizednormalsalinePrimeotherlinesinCRRTcircuitVerifycatheterplacementBedsideNurseReview,clarify,andnoteCRRTDrawbaselinelabsperCRRTordersExplainprocedureandanswerquestionsasneededCh

5、eckcannulatedlimbforcirculationCatheterIssuesDesign*largestdiameterw/shortestlengthDiameter19%↑=flow2x50%↑=flow5xIncreasingfrom2.0mmto2.1mmincreasesflow21%Length19%↑indiameterwillcompensatefordoublingoflengthPlacementSite*RIJ(LIJ,IVC,Subclavian)Tip*wellwithint

6、heatriumCatheterIssuesCatheterflowEarly–malpositionKinkTipmalposition–toohigh/lowTipmalposition–arterialagainstthewallTightsutureTipinwrongvesselLate–thrombosisorfibrinsheathformationCatheterIssuesCatheterrelatedinfectionLocalExitsite–s/sredness,drainage,crust

7、ing,swelling,odor,orpainTunnel–s/sswelling,pain,rednessorabilitytoexpressdrainingdownthetunneltracktotheexitsiteSystemicCatheterrelatedbacteremiaTreatmentInitiationNephrologyNurseAssesspatient’scondition*fluidandelectrolytePrepcatheterportsAspirateappropriateb

8、loodvolumefromcatheterandflushw/salinePrimeCRRTcircuitw/primingsolutionandattachbloodlinesofequipmenttocatheter(s)StartcitratedripAfter5’w/stableVS,startreplacementfluidandultrafil