successful introduction of continuous renal replacement therapy
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8/2/2019 Successful Introduction of Continuous Renal Replacement Therapy
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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.
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2 | Prepared by Dr. P.R. Asman. CEO MEDIWISE.
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
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3 | Prepared by Dr. P.R. Asman. CEO MEDIWISE.
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.
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4 | Prepared by Dr. P.R. Asman. CEO MEDIWISE.
1. Initial Training of KATH staff at MEDIWISE Training Centre (January 2011)
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5 | Prepared by Dr. P.R. Asman. CEO MEDIWISE.
2. More Training of KATH personnel at MEDIWISE training Centre (January 2011)
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6 | Prepared by Dr. P.R. Asman. CEO MEDIWISE.
3. Training of ICU staff at KATH A&E Centre (March 2012)
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7 | Prepared by Dr. P.R. Asman. CEO MEDIWISE.
4. Training of ICU & Renal Dialysis Staff at KATH A&E Centre (March 2011)
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8 | Prepared by Dr. P.R. Asman. CEO MEDIWISE.
4. The Two CRRT machines Ready for use on Patients (March 2011)
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9 | Prepared by Dr. P.R. Asman. CEO MEDIWISE.
5. First Patient Connected to the CRRT Machine at KATH ICU (March 2012)
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10 | Prepared by Dr. P.R. Asman. CEO MEDIWISE.
5. KATH ICU Nurse recording Patient Parameters on CRRT (March 2012)
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11 | Prepared by Dr. P.R. Asman. CEO MEDIWISE.
6. CEO of KATH witnessing Patient under CRRT treatment (March 2012)
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12 | Prepared by Dr. P.R. Asman. CEO MEDIWISE.
7. Metabolic Waste Removed from Patient after CRRT treatment (March 2012)
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