Starting up a continuous renal replacement therapy program on ICU

The questions as to which treatment is the most effective for the replacement of renal function in critically ill patients with acute renal failure and the qualifications needed by nurses to manage the continuous renal replacement therapy (CRRT) device are part of an ongoing debate between nephrologists and intensivists, between nurses of the renal ward and the ICU.

The keys to a successful CRRT program are a well-balanced and practical education program, a user-friendly dialysis machine, and technical support 24 h/day. A computerized data management system will diminish the workload to an acceptable level.

Intensive care nurses on our ICUs are well trained to execute CRRT without the involvement of nephrology nurses. On the ICU, the 24-hour presence of an intensivist is an additional advantage to solve medical problems involving CRRT. The daily cost of CRRT is only dependent on the devices and independent of human resources.

Initiating and maintaining a CRRT program is a great challenge for the ICU nurse. The possible problems remain within the ICU staff's ability to solve if they follow an education program. If the workload for the nurses is well monitored, extra personnel can be avoided.