080 SLOW LOW-EFFICIENCY DIALYSIS IN INTENSIVE CARE UNIT

Abstract

Category: Nursing Issues (education, training, care delivery) Presenter: Mrs HELEN BLACKMAN Keywords: SLED, ICU, dialysis Sustained low-efficiency dialysis (SLED), in which conventional haemodialysis machines are used to provide extended duration RRT (8 - 12 h vs 3-4 h with intermittent haemodialysis), has emerged as an alternative to CRRT for patients with hemodynamic instability. Whereas CRRT often necessitates some form of anticoagulation to prevent filter clotting, SLED may be readily performed with no anticoagulation. A session of SLED, especially if performed during the overnight hours, may be scheduled around tests and procedures and is thus less likely to be interrupted. Observational studies have suggested comparable clinical outcomes, and in some cases lower costs, in patients treated with SLED as compared to CRRT In City Hospital Sunderland a training program for Intensive care unit (ICU) nursing staff was undertaken. Over the last 30 years AKI renal replacement therapy treatment in ICU were performed by dialysis nursing staff. Using a nurse educator and multiple Plan do study act (PDSA) cycles a frame work for educating ICU nursing staff was created. In conjunction with this an electronic prescribing and administrating tool was developed. A SLED nurse champion from ICU was part of the first 12 senior ICU nurses trained. One week induction program in the main renal unit. A competency based assessment was developed with national UK ICU competency frame work. Theory and supervision taught by 1:1 by senior nurse from the main renal unit. Every learning opportunity logged and reflected on as a learning outcome. All dialysis was still prescribed by the on-call renal physician via an electronic prescription in collaboration with the ICU team. Anti-coagulation of the dialysis circuit used for SLED ranged from saline flushes to standard heparin and citrate concentrate. ACT testing for heparin administration. Electrolyte management with different dialysis concentrates. Management of common scenarios such as hypotension, bleeding and anaphylaxis in simulation environment. Vascular access for RRT was standardised and lessons learnt regarding vascular catheter placement and length of catheter for ICU doctors. Regular education meetings and a joint email to share questions, information, reflect and feed back on cases. Senior leadership to maintain the momentum of the program and adopt a culture of change was vital. A total of 4 ICU nurses have been trained to date as independent dialysers with 12 in the pipeline for the future. Mentor-ship is being developed. We continue to learn as further refinement is being made to the electronic prescription and training program.