What is Continuous Renal Replacement Therapy?
CRRT is a blood purification procedure used to sustain kidney function in patients with acute kidney injury, sepsis-like syndrome, and multi-organ failure, particularly those who are hemodynamically unstable.
The patient's blood passes through a blood purification machine, filtration, and blood warmer during CRRT dialysis therapy. This blood purification therapy is a slow, continuous process that can operate 24 hours a day to remove fluid and uremic toxins from the patient's blood and return the blood to the patient's body. This therapy improves haemodialysis tolerance in patients with unstable pulse rates and blood pressure. CRRT therapy is regarded as both a life-saving and a life-sustaining treatment.
Types of CRRT
Various CRRT techniques are distinguished by their waste elimination processes.
- Continuous Venovenous Hemofiltration (CVVH)
- Continuous Venous Haemodialysis (CVVHD)
- Continuous Venovenous Hemodiafiltration (CVVHDF)
Indications of CRRT
There are common and uncommon indications of CRRT for the treatment of acute renal failure when complicated by any of the following:
The most common indications of CRRT
- Kidney failure with insufficient blood pressure treated with multiple life-sustaining drugs
- Kidney failure with an increase in extracellular fluid (ECF) volume, associated with volume overload and severe cardiac failure.
- Renal failure accompanied by acute or chronic liver failure and cirrhosis.
- Cerebral oedema or brain swelling along with Kidney failure
- Hyper catabolism refers to an abnormally high metabolic decomposition of tissue or substance that causes physical deterioration and weight loss.
Less frequent manifestations of CRRT
- Systemic inflammatory response Syndrome (SIRS)
- Septicaemia or sepsis
- Multiple organ failure disorder
- Tumour lysis syndrome.
What does this treatment involve?
The patient will require the placement of a haemodialysis catheter. A large IV catheter is implanted into a vein in the neck or groin of the patient. The physician who inserts the IV catheter will sedate the area with lidocaine and may administer pain medication or sedation to make the patient more comfortable. You will be asked to leave the room during this procedure because it will be performed under sterile conditions.
Once this catheter has been inserted, CRRT can commence. A large CRRT machine will be placed next to the bed of the patient. It is essential that the nurse has access to the machine at all times. Please be mindful of the machine, bags, and tubing, and please be cautious not to touch the machine in any way, as it is very sensitive equipment.
How long will CRRT be required?
The CRRT treatment is intended to be temporary in the hopes that the kidneys will recover and resume normal function. The duration of the patient’s CRRT treatment will depend on how well they tolerate the treatment and what other medical issues they may be experiencing at the time. There is however a chance that the patient will require dialysis treatments in the future.
The team of health care providers, including the nurse and nephrologist (kidney specialist), will make decisions regarding the CRRT based on the response of the patient to the therapy.
Frequently, the nurse will be required to extract blood to assess the efficacy of the CRRT. Additionally, the nurse will examine the machine and IV pumps every hour.
The bags of fluid that are affixed to the dialysis machine must be frequently replaced by the nurse. The nurse will also monitor the catheter site and change the dressing as necessary.