Thread by @GasBugZa

Next up is renal clinical technologist Marissa Coetzee on 'Renal Replacement Modalities - 3 vs 12 vs 24h - A Carer's Perspective'
#CCSSA2022 #critcare #FOAMcc

Starts with an overview of the available therapies (with one-two examples of each but some have lots more).
Intermittent - IHD
Continous - CVVD, CVVHD
Hybrid - SLED
Peritoneal - CAPD, APD
#CCSSA2022

But what are the carer's concerns:
- Safety and efficacy of treatment
- Mobility and availability of the patient for other interventions
- Infection control risks
- Physical exertion of performing the critical taks (lifting bags etc...)
...

...
- Cost effectiveness
- Procedural simplicity
- Availability of equipment
#CCSSA2022

There can be a conflict between therapeutic priorities and practitioners - e.g. the renal tech vs the physiotherapist, the need for surgery or scanning whilst on dialysis
#CCSSA2022

CRRT
Advantages - haemodynamic stability, gentle solute removal, adequate nutritional support is possible
Disadvantages - continuous anticoagulation, mobilisation of patient is difficult, infection control, urea clearance limited.
#CCSS2022

IHD
Advantages - short duration, easy to perform, no anticoagulation, best K removal, less labour intensive, high machine availability
Disadvantages - requires water supply and a effluent drain point, cardiovascular instability, disequilibrium syndrome
#CCSSA2022

Hybrid - e.g. SLED, SLEDF
This can be done for a limited period, so may be 'best of both worlds' (e.g less anticoagulation, lower cost than CVVD, etc...)
Disadvantages - still needs a water supply and drain effluent, as well as unfamiliarity with the modality
#CCSSA2022

As clinicians, we need to consider these aspects and the human and physical resources we commit to the patient, and therefore potentially remove from other patients care. #CCSSA2022