Should CVVHD be 1:1 - page 4

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... Read More

  1. Visit  xtine618 profile page
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    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.
  2. Visit  Ruby Vee profile page
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    Quote from xtine618
    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.
    our cvvhd patients are usually on insulin drips -- blood draws every hour. what are you drawing every two hours?
  3. Visit  xtine618 profile page
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    Quote from ruby vee
    our cvvhd patients are usually on insulin drips -- blood draws every hour. what are you drawing every two hours?
    ours 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.

    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.
  4. Visit  sister s profile page
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    Australia
  5. Visit  aking2157 profile page
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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
  6. Visit  ShaunES profile page
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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.
  7. Visit  Biffbradford profile page
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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*
  8. Visit  ShaunES profile page
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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.
  9. Visit  ckh23 profile page
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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.
  10. Visit  Piglet08 profile page
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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
  11. Visit  ICU4U profile page
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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 ...
  12. Visit  Bec7074 profile page
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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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