CRRT- Activated Clotting time

3/5/04

Campbelltown ICU is embarking on CRRT. Is anyone in a similar situation to our unit with limited pathology services and utilising activated clotting time instead of APTT? If so can discuss implementation, policies & equipment
required?

Thankyou
ICU CNE Level 5 Metropolitan

27/5/04

At the risk of sounding nasty, which I am not, why is CRRT being considered at all in a site with "limited pathology services"???

CRRT is a high level procedure that is only performed on highly sick people, so unless you have a close to Level 5 ICU (which means 24hr access to pathology) you probably shouldn't be doing it.

I know that what I am saying may cause some angst, but I am bringing this up so we can have an open discussion about this issue. If you disagree with me I would be very keen to know, and hear your specific arguments...

Director of Intensive Care, Level 5 Rural

27/5/04

I think the previous writer brings up an important issue here. Health care is now provided in a very litigious and media-scrutinised environment. When things go pear shaped and hit the courts (or themedia) your strongest defence is to demonstrate that you are working within accepted guidelines. In this country, the only widely agreedguidelines/standards (pertaining to intensive care units) are those promulgated by the Joint Faculty of Intensive Care Medicine. If you are operating outside these guidelines (particularly with regard to unit and hospital infrastructure) you may find defending yourself much more difficult.

It would be my expectation that any agency set up by the health department to attend to intensive care matters in this state should have the maintenance of a safe environment (for both patients and staff) as its primary concern .... and should be active in ensuring that area health services comply with JFICM minimum standards. If area health services cannot comply, then they should not expect provision of the service.

Co-Director Intensive Care Unit Metropolitan (Level 5 NSW, Level 2 JFICM)