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BACCN Presentation 2010

Presentation on updating renal replacement therapy for September 2010 BACCN conference
by

Andrew Mizen

on 1 August 2011

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Transcript of BACCN Presentation 2010

In the beginning this is a hole What were we using Number of Types trials 2-side port
3-stepped design Evaluation and Feedback sucking against vessel wall 3rd lumen reduces
internal circumference Literature Search No proven evidence to suggest which catheter
performs the best (Bellomo et al 2002) Vascular Access needs good flow
otherwise treatmnet non-effective No proven increased risk of infection
using femoral sites (Adam et al 2009) both side ports had access issues
insertion difficulty / different technique with stepped lines
access much more improved with stepped lines contacted a number of different companies that supply relevant equipment
two of the companies contacted followed up
established what other units in our network were using and what their experience was criteria for machines..... arranged two week trial for both machines
developed a feedback form
training for each machine tookplace throughout each trial Pre and Post dilution flexibility
higher flow rates/larger exchange volume capability
TPE capability
citrate capability Updating Renal
Replacement Therapy current haemofilters were old
small group formed Decided to review
Machines
Lines
Policies & Proceedures Methodology
literature searches
contacted hospitals in our network
conducted trials
visited specialist sites Both machines were used clinically
by a number of staff within the unit After both trials took place
feedback was summarised
looked at pros and cons for each machine

Overall, both machines well received! However! We felt that the Prismaflex was the right option for us on the grounds of;

more familiarity due to previous experience with Prisma
flexibility of pre/post dilution in therapy the next step Review the haemofilter prescription replacement rate by body weight;
a new idea to our unit
dose according to diagnosis developed a two armed prescription
35ml/kg/hr for multi-organ/septic patients (as per ICS guidelines)
25ml/kg/hr for single organ AKI patients
includes variances in amount of pre and post dilution administered In practice
new machines well recieved
a few early teething problems
flow rates are generally higher
we have used 8000ml/hr flow rates on one patient! The Future.... Re-examine anticoagulant prescription as we have been experiencing elevated APTTs
Total Plasma Exchange
Trisodium Citrate
?Dialysis by bodyweight Decided to Review
Machines
Lines
Policies and Procedures Summary

Lines - using stepped lines as they gave faster flow and less downtime
Machines - not much difference so we went with familiarity
Policies, Procedures & Prescription
Investigate using citrate

.....no complaints so far..... Thankyou Contact:
Andrew.Mizen@wsh.nhs.uk Sponsors:
Lilly
Lidco
Fukuda
Fresanius
Gambro Vascular Access
Full transcript