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

Area of Science:

• Nephrology
• Critical Care Medicine

Background:

• Continuous venovenous hemofiltration (CVVH) is a vital treatment for critically ill patients with multi-organ involvement.
• Effective management requires seamless integration of nursing care across intensive care and operating room settings.

Observation:

• Catheter function was maintained without infection, bleeding, or thrombosis during CVVH.
• The patient required vasopressors briefly but met most therapeutic goals.
• Anticoagulation management presented a challenge, with one instance of elevated activated partial thromboplastin time (aPTT).

Findings:

• CVVH therapy was successfully implemented and maintained in both ICU and OR environments.
• The patient's fluid balance, nutritional needs, and vital signs were adequately supported.
• A specific nursing recommendation emerged for hourly bedside ACTs alongside every 4-hour aPTTs in patients with coagulopathy.

Implications:

• CRRT therapies facilitate interdisciplinary collaboration between nephrology and critical care nursing.
• Focus is shifting from technical CRRT aspects to patient-centered nursing care.
• Enhanced monitoring protocols, like routine bedside ACTs, can improve anticoagulation safety in complex patients.