Drug Delivery During CRRT Remains a Challenge

Mar 21, 2017

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Symposium in AACN Advanced Critical Care responds to need to standardize care for patients receiving continuous renal replacement therapies.

ALISO VIEJO, Calif. – March 21, 2017 – Continuous renal replacement therapies (CRRT) offer an alternative to intermittent dialysis for critically ill patients whose kidneys are not functioning.

However, safe and therapeutic drug delivery present a challenge for clinicians managing patients undergoing CRRT due to the sheer multitude of variables, including patient-specific and CRRT-specific factors and their relationship with drug-specific factors.

The complexity of CRRT makes it essential that clinicians know the underlying principles influencing medication dosing and delivery.

An article in the current issue of AACN Advanced Critical Care, “Considerations for Medication Management and Anticoagulation During Continuous Renal Replacement Therapy,” outlines the drug, patient and CRRT-specific factors that clinicians should incorporate into drug dosing and monitoring during CRRT.

The article is co-authored by Ashley Thompson, PharmD, BCPS, BCCCP; Fanny Li, PharmD, BCPS, BCCCP; and A. Kendall Gross, PharmD, BCPS, BCCCP. The authors are critical care pharmacists at the University of California, San Francisco (UCSF) Medical Center as well as health sciences clinical faculty members in the department of clinical pharmacy, UCSF School of Pharmacy.

“Frontline clinicians need to understand the basic principles of medication dosing and monitoring during CRRT,” Thompson said. “There are so many medications used in critical care that dosing information specific to CRRT is limited. Clinicians must be able to evaluate drug properties, CRRT modalities and their effects on medication clearance.”

For example, drug properties, such as plasma protein binding and volume of distribution, affect how a patient receiving CRRT may respond to a medication. In addition, interruptions in continuous therapy, such as during transport to procedures or circuit changes, may influence dosing adjustments.

A persistent barrier to continuous therapy is clotting within the CRRT circuit, which can lead to prolonged downtime off therapy. The article also presents an overview of systemic and regional anticoagulation options during CRRT, with best-practice strategies.

Supported by a case example, the article also reviews monitoring strategies for drug response and troubleshooting considerations.

The article is part of a symposium of articles focusing on CRRT in the Spring 2017 issue of the peer-reviewed journal. Other articles include:

  • A review of best-practice recommendations for CRRT, with recommendations from a recent expert consensus conference
  • Three case vignettes that highlight different applications of CRRT based on patient-specific goals of therapy
  • A model for CRRT training and competency evaluation beyond initial orientation

Symposium editor Hildy Schell-Chaple, RN, PhD, CCRN, CCNS, is a clinical nurse specialist at UCSF Medical Center.

“Although CRRT is the most common renal support therapy used in critical care, there has been a gap in evidence-based-practice guidelines for this therapy until recently,” she said. “This symposium responds to the need for best-practice strategies and quality indicators for optimal CRRT care. It’s imperative that we standardize care for patients receiving CRRT in order to improve outcomes.”

Schell-Chaple will expand on the CRRT symposium with two sessions at the National Teaching Institute & Critical Care Exposition, the annual conference of the American Association of Critical-Care Nurses (AACN), May 22-25 in Houston.

About AACN Advanced Critical Care: AACN Advanced Critical Care is a quarterly, peer-reviewed publication of in-depth articles intended for experienced critical care and acute care clinicians at the bedside, advanced practice nurses, and clinical and academic educators. An official publication of the American Association of Critical-Care Nurses, the journal has a circulation of 4,845 and can be accessed at http://acc.aacnjournals.org/.

About the American Association of Critical-Care Nurses: Founded in 1969 and based in Aliso Viejo, California, the American Association of Critical-Care Nurses (AACN) is the largest specialty nursing organization in the world. AACN represents the interests of more than half a million acute and critical care nurses and includes more than 200 chapters worldwide. The organization’s vision is to create a healthcare system driven by the needs of patients and their families in which acute and critical care nurses make their optimal contribution.

American Association of Critical-Care Nurses, 101 Columbia, Aliso Viejo, CA 92656-4109; 949-362-2000 www.aacn.org; facebook.com/aacnface; twitter.com/aacnme