Abstract: SA-PO092

Improving CRRT Lifespan: A QI Initiative

Session Information

Category: Acute Kidney Injury

  • 003 AKI: Clinical and Translational

Authors

  • Reisinger, Nathaniel C., Penn, Philadelphia, Pennsylvania, United States
  • Negoianu, Dan, Penn, Philadelphia, Pennsylvania, United States
  • Besharatian, Behdad, Penn, Philadelphia, Pennsylvania, United States
  • Sethi, Akash Nair, Penn, Philadelphia, Pennsylvania, United States
  • Duffy, Margaret, Penn, Philadelphia, Pennsylvania, United States
  • Gumber, Ramnika I., Penn, Philadelphia, Pennsylvania, United States
  • Messana, Joseph A., Penn, Philadelphia, Pennsylvania, United States
  • Cohen, Jordana B., Penn, Philadelphia, Pennsylvania, United States
  • Wasserstein, Alan G., Penn, Philadelphia, Pennsylvania, United States
  • Chaknos, Michael, Penn, Philadelphia, Pennsylvania, United States
Background

Unplanned interruptions of continuous renal replacement therapy (CRRT) can impact patient care, nursing workflow, and value of care. At our center, a rapid blood flow rate (Qb) of 300 mL/min is used to minimize the need for anticoagulation. At this Qb, circuit lifespan should be 48 hours. Retrospective review of 4 weeks of data showed that over 50% of treatments last less than 24 hours. The optimal Qb to maximize filter life is not known. Furthermore, short catheter length is associated with decreased CRRT filter life in a randomized trial. We wished to explore whether increased blood flow and/or catheter position would be associated with improved filter life.

Methods

CRRT treatments were tracked prospectively for one month before and one month after our standard Qb was increased from 300 mL/min to 350 mL/min. The duration of treatment, reason for circuit discontinuation, and position of the tip of the catheter was noted. Kruskall-Wallis rank sum test was used to compare median circuit life as categorized by catheter position for the pre-intervention data set.

Results

Pre-intervention versus post-intervention, respectively, 23% versus 22% of CRRT circuits failed within 24 hours, 13% versus 13% failed between 24 and 48 hours, and 64% versus 65% expired having met their approved lifespan. Catheters in the upper 1/3 superior vena cava (SVC) had median lifespan of 36.5 hours (interquartile range 21-47). Catheters in the mid 1/3 SVC had median lifespan of 21 hours (interquartile range 14-27). Catheters in the lower 1/3 SVC had median lifespan of 48 hours (interquartile range 46.5-48). Catheters in the right atrium (RA) had median lifespan of 47 hours (interquartile range 40.5-48). p=0.0013 for the overall comparison.

Conclusion

Increasing blood flow rate to 350 mL/min did not decrease the percentage of treatments which clogged or clotted before 24 hours. However, more central catheter position was significantly associated with improved filter life. We intend to explore methods to improve catheter placement in the future.