Current State of Pediatric Continuous Renal Replacement Therapy (PCRRT):

A National Survey

AJ Tanner, RN, BSN, ML Heard, RN, TL Young, RN,

BSN, SF Wagoner, MBA, RRT

April J. Tanner, RN, BSNAdvanced Technologies CoordinatorChildren’s Healthcare of Atlanta at

Egleston

A National Survey

An national review of current trends in CRRT

An 18 question survey sent to pediatric centers that offer CRRT free-standing or based in adult facility

42 centers responded

Therapy Types

CVVH CVVHD CCVHDF All types

Therapy Types

22 of 42 centers offer all available therapies

Mean PCRRT pts per year: 12.8 (1-60) Median pts per year: 9

50% of centers have <10 patients per year Average daily census of ICU’s: 13

range of 5-27

System Set-up

21

17

3 3

0

5

10

15

20

25

ICU Dialysis ECMO Other

Staffing Ratios

19

1011

0

5

10

15

20

1:1 2:1 2:1 to 1:1

Logistics and Coordination of System Set-up

11 of 42 centers have no formal 24/7 coverage

In 93% of center’s RNs manage the pumpdialysis, ECMO, and physicians make up the other

% Charge structure

the dept.that sets up equipment receives revenue in majority of centers

21 of 42 centers also have daily charges• varied response as to where revenue goes

Managing the Program

MD Management Program Coordination

I CU/ Nephrology – 19 I CU - 16

I CU – 8 Dialysis - 8

Nephrology – 12 ECMO - 4

Other - 11

Education

Wide variety of teaching methods Didactic/hands on skills lab training

occurs in 69% of initial training sessions 12% require mentoring shifts 17% offer informal training 7% utilize bedside training methods

Education

Annual recertification - 43% More frequent recertification occurs

26%smaller volume programs

19% of programs have no formal annual competency or recertification programs

Many centers education programs are under review

Equipment

5

30

3 3

0

5

10

15

20

25

30

Pumps

Braun

Prisma

Baxter

Other 3

29

8

0

5

10

15

20

25

30

Filters

Pan

Gambro

Other

Equipment and Supplies

SolutionsCustom made - 36%Normocarb - 31%Remaining centers used a combination of

normocarb and custom or prismanate Med-comp is the catheter of choice in

45% of programs

Anticoagulation

40% utilize citrate 13 of 16 centers have

converted from heparin to citrate within the last 2 years

Centers using both change depending on patient needs

17

10

13

0

5

10

15

20

Anticoagulation

Citrate

Heparin

Both

What does all of this tell us?

Variable approaches to therapy, training, methods, equipment and supplies

National certification programshelp with consistency in training

PCRRT Registrypotential to help standardize managementdevelop protocolsreview outcomes