Should CVVHD be 1:1 - page 4

by kristenallene40 9,242 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


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    WOW! A vented patient on a 1:1? That's nuts in my opinion. An intubated patient is all apart of being an ICU nurse! We are always 2:1 except if our patient is on CVVHD, Aquaphoresis, has a balloon pump, or is in the CVU and is less than 24 hrs post op open heart sx regardless of stability. Theses patient are ALWAYS on a 1:1. Even the most stable patients can become unstable at any time.
    Last edit by aking2157 on Jan 4, '12
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    Quote from aking2157
    Theses patient are ALWAYS on a 1:1. Even the most stable patients can become unstable at any time.
    That's why they're 1:1.

    What's the difference between an intubated patient and someone on CRRT?

    If you lose an airway that's a lot bigger deal than your circuit clotting.

    I don't understand.
    Last edit by ShaunES on Jan 5, '12 : Reason: More content.
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    With CRRT you're constantly changing bags, adjusting removal rates, and the charting is time consuming.

    Someone on a vent ... well, you just watch them. *Yawn*
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    If the argument is that it's time consuming, then I agree, it can be time consuming. On the other hand, changing bags takes a minute or two at most, and fluid removal is simple.

    As for charting, I'm not sure how you guys do it, but it's pretty simple for us, just bang in the pressures and the fluid removed and you're done; when compared to the other hourly stuff you do it's not a big deal at all.

    Simply put if acuity is the reason you 1:1 these patients then I would reasonably expect ventilators to be 1:1.
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    Quote from ShaunES

    Simply put if acuity is the reason you 1:1 these patients then I would reasonably expect ventilators to be 1:1.
    I understand the point you are trying to make, but it is not all encompassing. For example, there is no need for a drunk that was combative in the ER and then tubed to be a 1:1 when he will be extubated in the AM. I really think 1:1 should be on a case by case basis except for those that are immediately 1:1 due to their condition such as liver tx and fresh hearts.

    I also agree that the CVVH is not that time consuming for me either, unless you are running into clotting issues and catheter issues. I think it depends on what equipment you are using and what flow sheet/charting your facility has in place.
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    Well, CVVHD is different from a ventilator in that it carries with it the risk of rapid - pump-driven! - exsanguination, and I've as yet seen no alarm system against THAT. And a nurse who thinks a clotted circuit is the "big problem" in cvvhd has not been sufficiently prepared to care for a patient on cvvhd.
    In our ICU, when a patient is on dialysis, the dialysis nurse stays at the bedside. So we're 1:1 for cvvhd, too. I hope that doesn't change.
    Last edit by Piglet08 on Jan 18, '12 : Reason: adding
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    [QUOTE=kristenallene40;3976394]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 neglected while I'm constantly monitoring and managing this guy. We have a great suport system in my unit, but it all falls back on my nursing license. I can't seem


    Where I work its 1:1 for cvvhd, I think it depends on when you start them.. are they truely septic and now all systems are failing or are you starting it earlier and there not so unstable yet.. it depends on your intensivist and your kidney doc and the nurse to recognize the need. We dont use prop. for sedation anymore and sometimes the vents are worse.. and if you just look at the machine .. which alot of replys did,,, no its not so complicated... but add your patient who has no pressure and a rhythm that sucks and stooling everywhere and without a tech or aide or whatever you call them and yea their a one to one patient ...
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    Our CRRT pts are almost always a 1:1. Only paired if A. Absolutely necessary B. they have good access with no difficulties running C. No major other issues (on pressures, Rotoprone, etc) I've never had one paired.


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