Continuous hemofiltration: nursing perspectives in critical care.

Daily hemofiltration circuit management in Australian ICUs is a nursing activity predominantly utilizing venovenous access and a BMM 10-1 (Gambro, Lund, Sweden) blood pump. The design of the hemofiltration circuit should enable the easy addition of replacement fluids, the administration of anticoagulant drugs, and the collection of ultrafiltrate (UF). The ability to measure circuit pressures both before and after the filter may assist in the understanding of circuit dynamics and the prediction of filter dysfunction. Ultrafiltration (vol/hr) can be maximized using readily available intravenous pumps; however, the limitations of this (i.e., volume accuracy) need to be considered. The day-to-day nursing management of patients undergoing continuous venovenous hemofiltration (CVVH) requires continuous assessment and monitoring to prevent complications associated with fluid/electrolyte imbalance, blood and heat loss, infection, poor UF production, and foreign substance reaction. We have found that the nursing staff, therefore, requires a variety of educational strategies to gain expertise and, thus, provide a high standard of nursing management for this therapy. Quality assurance is also a necessary adjunct to the safe and efficient use of CVVH.