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.
1 | 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. 2. 3. 4. Post traumatic renal shut down secondary to severe blood loss Perinatal blood loss leading to renal failure Eclamptic- induced renal shut down 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 patient leading 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 patient There is a third important use of this system and it involves the intermittent treatment 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 Military Hospitals 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
2 | 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 not honor 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.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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