Colleene Young RN, BSN, CCRN PICU Clinical Nurse IV Childrens Hospital Los Angeles

1. Nurse Responsibilities & Clinical Decision Making When Caring for Critically Ill Pediatric Patients Requiring Continuous Renal Replacement Therapy Colleene Young RN, BSN, CCRN PICU Clinical Nurse IV Childrens Hospital Los Angeles

2. Childrens Hospital Los Angeles 286-Bed tertiary care children’s hospital Affiliated with University Southern California Keck School of Medicine (20 bed PICU; 15 bed CTICU; 40 bed NICU) Hospital admissions annually >11,000 PICU admissions annually >1,100

3. Training, Competencies & Troubleshooting • Training includes one day class & two precepted shifts • All critical care fellows are required to attend hemofiltration class • Annual skills lab; nurses & fellows attend • Circuit changes & troubleshooting measures tracked

4. Patients/year, Length of Stay & Survival

5. Nurses present in rounds, actively participates in plan of care • Worksheet computes 24º total intake (infusions, meds & flushes) • Net (-/+) fluid balance determined; hemoflitration flow rates adjusted

6. Childrens Hospital Los Angeles Hemofiltration Order Sheets

10. Hemofiltration infusions, settings, volumes & net hourly fluid balance are documented in the electronic patient record

11. Hemofiltration used commonly as adjunct therapy with ECMO ECMO trained nurses are required to maintain competency to manage hemofiltration pump PICU nurses also manage CTICU hemofiltration

12. Hemofiltration may be continued when patients require surgery • PICU nurses manage hemofiltration intra-operatively • Study demonstrated benefit of CRRT during orthotopic liver transplantation • Your Text here • Patients with hepatic disease at risk for acute kidney injury • Maintaining an even or negative fluid balance beneficial

13. Thank You! Colleene Young RN, BSN, CCRN PICU Clinical Nurse IV Childrens Hospital Los Angeles Pediatric Intensive Care Unit 4650 Sunset Blvd MS # 74 Los Angeles, CA 90027 USA +1 (323) 361-2584 Lcyoung@chla.usc.edu