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Kidney Week

Abstract: PO0250

CRRT Dose Variation Across Multiple ICUs: A Single-Center Study

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Liske-Doorandish, Dariush, Medical University of South Carolina, Charleston, South Carolina, United States
  • Okamoto, Keisuke, Nara Kenritsu Ika Daigaku Fuzoku Byoin, Kashiwara, Nara, Japan
  • Browne, Maria Creciun, Medical University of South Carolina, Charleston, South Carolina, United States
  • Campbell, Ruth C., Medical University of South Carolina, Charleston, South Carolina, United States
  • McMahon, Blaithin A., Medical University of South Carolina, Charleston, South Carolina, United States

Group or Team Name

  • MUSC Nephrology CRRT QI
Background

Continuous Renal Replacement Therapy (CRRT) is increasingly a cornerstone of critical care provision in Intensive Care Units (ICUs) but variation in utilization and differences in culture of practice impact percentage of dose delivered, bearing on outcomes. Efforts to establish timing for initiation, modality, and type of anticoagulation continue, but standardizing local practice may be a more feasible route to improvement, through establishing standards across units and measuring adherence to those standards.

Methods

Our single center quality improvement study aimed to assess differences in CRRT utilization, clotting events, percent CRRT dose delivered, and other contributors to differences in CRRT delivery. This initial study is part of a long-term quality improvement project to identify routes to improve CRRT dose delivery and further evaluate CRRT modalities best suited to different ICU environments. We tracked “clotting events,” “filter life,” and “percent dose delivered,” to assess unit specific practice patterns and outcomes. Our study was undertaken from 02/2017 to 07/2019, and includes 150 ICU patients who received CRRT across our system’s 5 adult ICUs.

Results

We found CRRT delivery ranging from 92.7% to 96.4% of prescribed dose across our ICUs, with 12,745 hrs of CRRT delivered out of 13,575 hrs CRRT prescribed, and a weighted mean of ~7.8 hrs undelivered CRRT per patient for all patients in the study; average <0.05 hrs undelivered CRRT/patient/day. Undelivered CRRT ranged from 3.4 hrs/patient in the Medical ICU to 13.1 hrs/patient in our Cardio Vascular ICU; the use of a smaller French catheter size for the patients on a specialty surgical ICU, and interruptions for surgical procedures, accounted for the greatest deviation from the mean for undelivered CRRT; significant inter-unit variability of delivered CRRT dose per patient was also noted.

Conclusion

Increased clotting events and decreased percent dose delivery were associated with the use of smaller catheters, and significant variation in average undelivered hours of CRRT per patient across the different units, both of which highlighted the need for shared institutional standards and more frequent measuring of adherence to those standards to improve overall CRRT delivery.

Funding

  • Clinical Revenue Support