Should CVVHD be 1:1 - page 3
by kristenallene40 | 9,401 Views | 37 Comments
Should it be required that pts on CRTs be kept at a 1:1 ratio? I have a very unstable pt on CVVHD but also have to take on another pt cause my hospital doesn't require 1:1. I think it is ridic because my other patient gets super... Read More
- 0Dec 18, '10 by stram87They are usually 1:1 on our unit. Though the amount of work needed can vary greatly from shift to shift. Sometimes the CVVHD will run smoothly the entire shift and the only work needed is changing the bags up. Other times it will be alarming every 5 min related to unseen air bubbles or access pressure problems. I think that if staffing permits CVVHD patients should be 1:1 because you never know when your going to start having problems and you wont be able to leave the room.
- 0Jan 5, '11 by NickiLaughsI've only seen one CRRT, and that's at my new facility. He was incredibly unstable on a 1:1....but he had more drips going than I had seen on most of the fresh open hearts at my old facility. And had coded the day before.
Based on what I saw, if most CRRT's are like that, I would deem a facility out of their mind if that was placed on a 1:2
- 0Jan 24, '11 by oregonnurse2007CRRT at my hospital is a 1:1, on occasion if we are holding an overflow med/surg pt or a not-medically-cleared psych pt it will be paired up with that. IABP are 1:1, but not vents. I routinely have two vent patients, and it is very manageable. Also if we have someone on frequently titrated pressors that pt is 1:1. If we have a pt that's on 3 or more machines then it is a 2:1, ie vent, CRRT, IABP, ECMO, VAD. Sorry that your manager does not see this. Would the AACN have any literature on best practice for CRRT patients? If it supports 1:1, maybe you could bring this up to him/her?
- 0Jan 26, '11 by s_elliott52It may be wrong to tell you guys this but the UK the recommendations are that vent, CRRT, IABP all 1:1 even if they are not sedated. Any HDU/ward patient can be 1:2 but normally on my unit 1:1. Any patient on ECMO/VAD are always strictly 2:1, with once of these being an experiences and trained ECMO specialist....Tell me again why I want to move to USA!!!
- 0Feb 21, '11 by xtine618I have only taken care of CRRT patients on a citrate gtt and even those patients who are stable are still busy! Our protocol requires us to draw labs q 2 hrs and depending on the settings, I could be changing dialysate and replacement bags every 1.5 hrs. And those don't usually fall on the same schedule. I am usually doing something every 15-30 minutes. And that's if they're stable. I would not feel comfortable having a second patient. Luckily in my facility they are 1:1.
- 0Feb 21, '11 by Ruby VeeQuote from xtine618our cvvhd patients are usually on insulin drips -- blood draws every hour. what are you drawing every two hours?i have only taken care of crrt patients on a citrate gtt and even those patients who are stable are still busy! our protocol requires us to draw labs q 2 hrs and depending on the settings, i could be changing dialysate and replacement bags every 1.5 hrs. and those don't usually fall on the same schedule. i am usually doing something every 15-30 minutes. and that's if they're stable. i would not feel comfortable having a second patient. luckily in my facility they are 1:1.
- 0Feb 21, '11 by xtine618Quote from ruby veeours are routinely on insulin gtts also, but i don't usually count those as lab draws since sometimes they are finger sticks. our patients on crrt either get heparin or citrate for anticoagulation. those on citrate gtts get ionized calciums drawn q 2 hrs. and each time they are drawn from 2 different sites. one from the patient and one from the machine. after it's resulted, we titrate the calcium and citrate gtts according to the protocol. and the most common mistake made in this process is the blood being mislabeled since both ionized calciums are being drawn at the same time.our cvvhd patients are usually on insulin drips -- blood draws every hour. what are you drawing every two hours?
not to mention serial chemistries being drawn q 4-6 hrs and needing replacement. sometimes it's hard to find time to go to the bathroom let alone find time to care for another patient. sure there are times that i could take another patient, provided that they were very stable and not on the call light every 30 minutes, but our policy (and luckily our staffing) supports 1:1 crrt.