Continuous Renal Replacement Therapy
What is Continuous Renal Replacement Therapy (CRRT)?
Continuous Renal Replacement Therapy (CRRT) is used in the intensive care unit when your loved one’s kidneys are not functioning properly. It is a form of dialysis that removes wastes, toxins, and excess fluid from the body. Essentially, CRRT does the work of the kidneys. It is a continuous slow-motion dialysis treatment that runs 24 hours a day until your family member’s condition improves to the point that they can tolerate standard dialysis, or they no longer require dialysis.
CRRT is used in the critical care unit because our patients are very sick, often with multiple medical problems. They are unable to tolerate a regular hemodialysis treatment, which only lasts about 3–4 hours, as it would be too strenuous for a patient who is already critically ill.
What does this therapy involve?
The patient will need to have a hemodialysis catheter placed. It is a large IV catheter that is inserted into a vein, either into their neck or groin. The doctor who places the IV catheter will numb the area using lidocaine and may give your loved one pain medicine or sedation during the procedure to make them more comfortable. You will be asked to step out of the room during this procedure, as it is done under sterile conditions.
Once this catheter is placed, CRRT can begin. A large CRRT machine will be next to your loved one’s bed. It is important for the nurse to be able to access the machine at any given time. Please be mindful of the machine, bags, and tubing, and please be careful not to touch the machine in any way, as it is very sensitive equipment.
How long will they require CRRT?
CRRT therapy is meant to be temporary with the hope that the kidneys will recover and return to normal functioning. The length of time your loved one will require CRRT depends on how well they tolerate the treatment and what other medical problems they may be dealing with at that time. However, there is a possibility that your loved one may still need to have dialysis treatments in the future.
The team of health care providers, including the nurse, intensivist, and nephrologist (kidney doctor), will work together to make decisions about the CRRT based on your loved one’s response to the therapy.
Ongoing care
Frequently the nurse will have to draw blood to monitor the effectiveness of the CRRT. The nurse will also be checking numbers on the machine and the IV pumps every hour.
The dialysis machine needs to have the bags of fluid that are attached to the machine changed frequently by the nurse. The catheter site is also monitored by the nurse and the dressing will be changed if needed.
What can I do to help during this time?
As a loved one of the patient, it is important to continue to take care of yourself during this stressful time. Make sure you are getting enough to eat and drink. Also, please make sure that you are getting enough sleep. The patient is most likely on multiple forms of life support and the room can become crowded. It’s important to try to declutter the environment of your belongings as much as possible in case there is an emergency.
Playing music at a reasonable level (at the discretion of your nurse) may be soothing for the patient and for the loved ones at the bedside.
Please do not hesitate to ask the nurse or doctor any questions you have regarding the dialysis. We will always do our best to ensure you are informed and aware of what is taking place.