successful introduction of continuous renal replacement therapy

8/2/2019 Successful Introduction of Continuous Renal Replacement Therapy

1/12

1 | Prepared by Dr. P.R. Asman. CEO MEDIWISE.

SUCCESSFUL INTRODUCTION OF CONTINUOUS RENAL REPLACEMENT THERAPY

(CRRT) AT THE KOMFO-ANOKYE ACCIDENT AND EMERGENCY (A&E) CENTRE

INTRODUCTION

The planning of the A/E Centre at KATH included the provision of two (2) CRRT

systems at the Intensive Care Unit (ICU). However, the systems have been

standing idle since commissioning of the Centre.

On Thursday 15th

of March 2012 a patient, with acute chronic renal failure was

successfully treated on one of the machines by a team of doctors and nurses from

the A/E Intensive Care Unit supported by two experienced nurses from the Renal

Dialysis Unit of the Hospital, the Nephrologist at the Department of Medicine of

KATH and a Biomedical Engineer from MEDIWISE International Company Limted.

This successful outcome has been the result of various application training

programs on the new technology for the personnel of the hospital by MEDIWISE

and the provision of seed consumable by GERTECH. As a consequence to this

successful outcome the CEO of the Hospital has decided to place an order for

more consumable to support the beneficial use of the systems on patients.

BACKGROUND

CRRT equipment allows the treatment of a patients blood outside the body

(Extracorporeal Treatment). The primary use of this system is in the Intensive

Care setting where a sick patient on a ventilator and/ or invasive monitoring of

vital signs requires removal of metabolic waste or accumulated fluids from the

body as a result of renal insufficiency. In such situations, conventional practice

has been the transfer of such patients to the Renal Dialysis Unit. Experience has

shown, however, that the transfer and handling of such patients for Dialysis

outside the Intensive Care Unit is froth with difficulties and complications with

very high mortality rate.


2/12


CRRT allows this treatment to be bought to the patients bedside without the

patient being moved at all. The potential benefit of this primary use of CRRT is

life- saving for critically ill patients with hemodynamic instability. These may

include;

1. Post traumatic renal shut down secondary to severe blood loss2. Perinatal blood loss leading to renal failure3. Eclamptic- induced renal shut down4. Patients with accumulated fluids (pulmonary edema, cardiac tamponard,

etc.) with poor response to diuretics

The Secondary use of CRRT involves the removal to harmful substances from the

blood. This non renal use includes but not limited to the following;

1. Removal of products of infection (Cytokines) from the septicemia patientleading to rapid recovery.

2. Removal of drugs as a result of overdose or abuse from the blood.3. Removal of snake poison from the blood. (This is very common practice in

India)

4. Replacement of the total plasma (blood without the cells) in a patientThere is a third important use of this system and it involves the intermittenttreatment of patients with Chronic Renal Failure. In this treatment mode waste

removal from the blood is one step better than standard dialysis since the process

involves both diffusion (dialysis) and convection (filtration). It is worth noting that

CRRT system does not require a water treatment plant like the standard dialysis

system but uses available sterile solutions.

The Ghana Situation

In the country CRRT is currently available only at the KATH and the 37 MilitaryHospitals thanks, to Dr Nsiah Asare (former KATH CEO) and DR Graham (Intensive

Care Consultant, 37 Military Hospital) who, respectively, were instrumental in the

introduction of the technology into the country under the GERTECH projects for

the two hospitals. In both places the medical staff is just about actually putting

the machine on a patient due to time required for various application training


3/12


programs, in-country technical capacity building and delays in consumable

ordering from the manufacturer. In this respect KATH has taken the lead as the

first Hospital in Ghana to put the equipment to use.

It is worth noting here that B.Braun, the manufacturer of the equipment does nothonor orders for consumable supply until technical and application training have

been carried out to safeguard the safe use of the equipment on patients. In this

respect MEDIWISE has, with the support of B. Braun and through GERTECH, built

this essential capacity and this was brought to bear on the successful use of the

equipment by KATH.

It is recommended therefore that the Ministry of Health (MOH) should avail itself

of this capacity to introduce the technology to all tertiary and secondary level

facilities in the country to enhance health care delivery.

Below are pictures of this success story.


4/12


1. Initial Training of KATH staff at MEDIWISE Training Centre (January 2011)


5/12


2. More Training of KATH personnel at MEDIWISE training Centre (January 2011)


6/12


3. Training of ICU staff at KATH A&E Centre (March 2012)


7/12


4. Training of ICU & Renal Dialysis Staff at KATH A&E Centre (March 2011)


8/12


4. The Two CRRT machines Ready for use on Patients (March 2011)


9/12


5. First Patient Connected to the CRRT Machine at KATH ICU (March 2012)


10/12


5. KATH ICU Nurse recording Patient Parameters on CRRT (March 2012)


11/12


6. CEO of KATH witnessing Patient under CRRT treatment (March 2012)


12/12


7. Metabolic Waste Removed from Patient after CRRT treatment (March 2012)

successful introduction of continuous renal replacement therapy

Documents