Nursing for Renal Replacement Therapies in the Intensive Care Unit: Historical, Educational, and Protocol Review

Nurses have made a significant contribution to the development and application of dialysis in the 1950s and continuous renal replacement therapies (CRRT) in the Intensive Care Unit (ICU) setting from the 1980s. Any treatment requires patient and machine-circuit preparation, connection of the extracorporeal circuit (EC) to the patient vascular access catheter and regular tasks to maintain a treatment in progress. During treatment, nurses prepare fluids, adjust fluid settings to provide fluid balance, prepare electrolyte additives, monitor acid base and electrolyte levels, monitor patient and machine 'vital signs', and then when necessary diagnose circuit clotting and perform a disconnection of the EC from the patient. All of these aspects of CRRT nursing are essential to a suitable nursing policy or protocol. This paper provides a clinical review for this every day sequence when using CRRT in the ICU setting.