Abstract:

Objective To construct a prevention and management scheme of unexpected interruption of continuous renal replacement therapy with regional citrate anticoagulation（RCA-CRRT） in ICU patients，and to provide a theoretical basis for reducing the probability of unexpected interruption and improving the efficiency of continuous replacement therapy. Methods Based on fault tree theory，a prevention and management scheme of unexpected interruption of RCA-CRRT in ICU patients was drafted through literature review. Then the expert correspondence questionnaire was prepared，and the Delphi method was used to conduct expert consultation. Combined with the coefficient of variation，average score and expert opinion of the items，the contents of the scheme were amended and screened，forming the final scheme. Results Twenty experts were selected for two rounds of letter consultation. The final effective recovery rates of both rounds were 100%，the expert authority coefficient was 0.943 and 0.958，and the Kendall’s W was 0.224 and 0.229，respectively. The prevention and management scheme for unexpected interruption of RCA-CRRT in ICU patients was finally formed，including 5 first-level items（individual patient level，CRRT treatment level，catheter function level，quality control level，instrument and equipment level），15 second-level items and 60 third-level items. Conclusion The scheme which constructs from five levels provides a basis for the standardization of the management of RCA-CRRT，helps to further improve the use efficiency of extracorporeal circulation filter，optimize the allocation of medical resources and improve the therapeutic effect.

Key words: Continuous Renal Replacement Therapy, Regional Citrate Anticoagulation, Unexpected Interruption, Delphi Method, Scheme Construction, Fault Tree Theory, Nursing Care