COVID-19 大流行紧急情况下新型 CRRT/PIRRT 设备的部署：组织挑战和实施结果。

Deployment of a New CRRT/PIRRT Device during the COVID-19 Pandemic Emergency: Organizational Challenges and Implementation Results.

机构信息

Division of Nephrology, Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA,

Division of Nephrology, Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA.

出版信息

Blood Purif. 2021;50(3):390-398. doi: 10.1159/000511726. Epub 2020 Nov 10.

DOI:10.1159/000511726

PMID:33171460

Abstract

INTRODUCTION

The coronavirus disease 2019 (COVID-19) pandemic led to increased demand nationwide for dialysis equipment, including supplies and machines. To meet the demand in our institution, our surge plan included rapid mobilization of a novel continuous renal replacement treatment (CRRT) machine named SAMI. The SAMI is a push-pull filtration enhanced dialysis machine that can conjugate extremely high single-pass solute removal efficiency with very precise fluid balance control.

MATERIAL AND METHODS

Machine assembly was conducted on-site by local biomedical engineers with remote assistance by the vendor. One 3-h virtual training session of 3 dialysis nurses was conducted before SAMI deployment. The SAMI was deployed in prolonged intermittent replacement therapy (PIRRT) mode to maximize patients covered per machine per day. Live on-demand vendor support was provided to troubleshoot any issues for the first few cases. After 4 weeks of the SAMI implementation, data on treatments with the SAMI were collected, and a questionnaire was provided to the nurse trainees to assess device usability.

RESULTS

On-site installation of the SAMI was accomplished with remote assistance. Delivery of remote training was successfully achieved. 23 PIRRT treatments were conducted in 10 patients. 7/10 of patients had CO-VID-19. The median PIRRT dose was 50 mL/kg/h (IQR [interquartile range] 44 - 62 mL/kg/h), and duration of the treatment was 8 h (IQR 6.3 - 8 h). Solute control was adequate. The user response was favorable to the set of usability questions involving user interface, on-screen instructions, machine setup, troubleshooting, and the ease of moving the machine.

CONCLUSION

Assembly of the SAMI and training of nurses remotely are possible when access to vendor employees is restricted during states of emergency. The successful deployment of the SAMI in our institution during the pandemic with only 3-h virtual training supports that operating the SAMI is simple and safe.

摘要

简介

2019 年冠状病毒病（COVID-19）大流行导致全国范围内对透析设备（包括用品和机器）的需求增加。为满足我们机构的需求，我们的应急计划包括快速调动新型连续肾脏替代治疗（CRRT）机器，命名为“SAMI”。SAMI 是一种推拉过滤增强型透析机，可将极高的单次溶质清除效率与非常精确的液体平衡控制相结合。

材料与方法

机器由当地生物医学工程师现场组装，供应商远程协助。在 SAMI 部署之前，对 3 名透析护士进行了 1 次为期 3 小时的虚拟培训课程。SAMI 以延长间歇性替代治疗（PIRRT）模式部署，以最大化每台机器每天覆盖的患者人数。在最初的几个病例中，提供现场按需供应商支持以解决任何问题。在 SAMI 实施 4 周后，收集了使用 SAMI 的治疗数据，并向护士培训生提供了一份问卷，以评估设备的可用性。

结果

SAMI 的现场安装通过远程协助完成。远程培训的交付取得了成功。在 10 名患者中进行了 23 次 PIRRT 治疗。7/10 的患者患有 COVID-19。PIRRT 剂量中位数为 50 mL/kg/h（IQR [四分位间距] 44-62 mL/kg/h），治疗时间为 8 h（IQR 6.3-8 h）。溶质控制充足。用户对涉及用户界面、屏幕上的说明、机器设置、故障排除以及移动机器的简便性的一系列可用性问题的反应良好。