Local experience with the use of sustained low efficiency dialysis for acute renal failure.

Renal replacement therapy (RRT) is a common therapy used to treat critically ill patients in acute renal failure. Currently a number of dialysis modalities are used such as haemodialysis, continuous renal replacement therapy (CRRT), and sustained low efficiency dialysis (SLED). As SLED is a recently implemented RRT, very little literature is available on the nursing aspects of SLED. This paper shares the local nursing experience of using SLED, thus providing a nursing perspective. Between 2002 and 2006, 103 patients were treated with SLED resulting in 307 SLED treatments. Early problems encountered involved patient hypotension, dialysis catheter patency and water quality; all of which were overcome by initially commencing dialysis at a lower prescribed blood pump rate, using larger catheters and improving water quality. Nursing advantages of SLED over CRRT included being able to release the patient for nursing activities and patient transfer out of the ICU for investigations and procedures; reduced nursing workload related to less machine and patient monitoring during the dialysis procedure; and cost reduction. Disadvantages of SLED are related to poor water quality, accessibility of water supply and limited space to house the two machines required. SLED has proven to be a nurse friendly dialysis modality for critically ill patients with acute renal failure.

Local experience with the use of nasal bubble CPAP in infants with bronchiolitis admitted to a combined adult/paediatric intensive care unit.

Bronchiolitis is an acute inflammatory disease of the lower small airways predominantly occurring in infants younger than 1 year of age. As a result of the respiratory distress associated with bronchiolitis, infants frequently require admission to an intensive care unit for respiratory support. Thirty-five infants diagnosed with bronchiolitis were admitted to a combined adult/paediatric tertiary intensive care unit over a 2-year period for nasal bubble continuous positive airway pressure (CPAP). Following this therapy, 20 (57.14%) of these infants could be transferred to the medical ward of the onsite paediatric hospital. The remainder required transfer to the national paediatric intensive care unit (PICU) for ongoing observation and/or positive pressure ventilation. Nasal bubble CPAP is a simple therapy that can be easily set up at the bedside. The use of nasal bubble CPAP enabled infants to remain in their geographical area, thus improving family visiting access and reducing the demand for paediatric beds in the national PICU.