Aust Crit Care
-
As technological developments continue to offer patients more health care choices patient acuity increases. Patients that traditionally would have been cared for in a critical care environment are increasingly located on general wards. This change impacts on the acute care sector in a number of ways. ⋯ This paper analyses the literature on the factors that contribute to suboptimal ward care of the acutely ill patient. It uses the categories proposed by McQuillan et al. (1998) in relation to suboptimal ward care in an attempt to develop a conceptual analysis of the factors that influence suboptimal ward care and acutely ill ward patients. Thus it aims to develop and enhance practitioners' knowledge and understanding of this topic and therefore improve patient care outcomes.
-
The use of citrate to anticoagulate the Continuous Renal Replacement Therapy (CRRT) circuit has not been widely adopted in Australia as an alternative to heparin due to treatment complexity and risks of metabolic complications and availability of suitable solutions. However, interest persists in citrate anticoagulation as a viable alternative when heparin is either contraindicated or has failed to provide an adequate circuit lifespan due to dialyser clotting. ⋯ This paper describes a practical protocol for the delivery of regional citrate anticoagulation for pre-dilutional CVVHDf. The protocol maintains the flexibility in dialysis/haemofiltration dose prescription and advises on the requirement for monitoring and necessary adjustments to prevent the development of metabolic disturbances. This may assist regional citrate to achieve wider acceptance as an alternative anticoagulation strategy for critically ill patients.