Case study: end stage liver failure patient managed with CAVH pretransplant

The patient met 4 of the 5 expected outcomes. Effective therapy with CAVH was maintained in the ICU setting and in the operating room. The catheters functioned throughout the entire treatment without signs or symptoms of infection, bleeding, or thrombosis. She received hyperalimentation, filtration replacement fluid, and adequate fluid boluses to maintain volume status, nutritional requirements and vital signs. Cardiac vasopressor medications were required for a short period. The one problem that did occur was related to the anticoagulation therapy. The PTT was checked every 4 hours and the heparin drip was titrated to keep the PTT at 50 to 60 seconds. At one point, the PTT was 92 seconds but immediate measures were undertaken to reverse the condition. In the situation where a patient has an underlying coagulopathy and a potential source of bleeding, the nursing recommendation is that hourly bedside ACTs with every 4 hour PTTs should be performed as a routine part of the care. CRRT has been used successfully in critically ill unstable patients with multiorgan involvement. These therapies provide an avenue for collaboration between nursing professionals in nephrology and critical care. The focus of CRRT can now progress from the technical aspects of the procedures to patient centered nursing issues.