Is there a need for a nurse emergency team for continuous renal replacement therapy?

Abstract

The use of an emergency response team for unwell patients has provided an improvement in hospital care standards by reducing medical and postoperative adverse outcomes. Use of a nurse emergency team for patients treated with continuous renal replacement therapy (CRRT) also has potential to reduce adverse outcomes with CRRT, where staff may lack experience or find troubleshooting CRRT difficult in an ICU with many critically ill patients in their care. Differing nursing models are used to provide CRRT in the ICU, and all of these could benefit from a nursing response team at some time. The response must be immediate, with suitably available and CRRT-experienced nurses. As with medical emergency team use, the nursing emergency team for CRRT would be called when a deviation from a standard criterion list occurs. The list could include: prolonged blood pump stoppage (approximately 2 min); air detection alarm; blood leakage; sudden circuit pressure changes-transmembrane pressure (>200 mm Hg) or venous pressure (>200 mm Hg) or arterial pressure negative (>or=100 mm Hg); the need to override a fluid balance alarm 3 times in 5 min; patient hypotension; cardiac arrest or similar event, or the nurse is concerned that the machine is malfunctioning. The 'human resource' is the biggest challenge to developing a suitable response team 24/7, however where ICU and nephrology nurses work in a collaborative approach for CRRT, a response team would be more easily established and may not be required continuously.