CRRT: Who does it?? - Page 3

Interesting. How does your dialysis staff drain their effluent? In a bag? Of course not, down the drain (some even in the sink.) There are about 70 major university and academin centers that use the Nxstage that the infection control depts have not had an issue with the drain line, and this is likely because, as you know the effluent is sterile. It is filtered thru the hemofilter ports, and bacteria cannot get in or go out. Of course, if you love lugging bags, you should stick with the bag system. I am sure you also recently saw the story in Nephrology News and Issues, April 2006 that found that Gambro was linked to 9 deaths and 11 injuries with their Prisma machines (not to mention all the non reported deaths) because of the incompetant scale system. Might want to make sure your patient is not having adverse effects from those wonderful machines. The FDA has put them in a no sell, no import situation until further notice this was so severe.

That scale issue is the nurse not correcting alarms, effluent in the line will grow yeast within 12 hours. Our infection control vetoed the use. We just drain the effluent line in a container or toliet. I have no problem lugging. Look at NxStage they are in the hole financially, I also heard Gambro will get their import ban lifted. I am sure that NxStage and the other companies will have issues with the FDA too. NxStage is so new that they couldn't have the volume of treatments where as Gambro has done what a million? vs. 200 by NxStage? , Their scales are very accurate they are weighed where as Nxstage just dumps!! We only have specific beds used for dialysis and when they drain it is only in 4 hours not draining across for 24 hours. I also wouldn't want to lift all that weight above my head!! We also called JCAHO and they stated this was probably not acceptable. We have never had a problem with patients because we answer are alarms. I saw that NxSatges screen and you get codes I would think that would be hard to troubleshoot.

I did acute dialysis for 9 years--we set up the machines and were available 24hrs a day with a 1 hr response time to reset up the machine and to be there for the ICU RN if there were problems. I am now working again as an ICU nurse (too much CRRT call) and am seeing the other side of it. We used Prismas but now have changed to Nxstage--you still lug bags to the nxstage--and yes it's nice to not have to empty effluent bags--we put a plastic cord piece over the drain hose to stop the tripping, but my big concern that no one else seems to be worried about is the size of the Nxstage filter--240ml! vs. the Prisma's 80ml. Everytime we clot a filter we throw out 240ml of blood!!! I am doing ed classes to work on the things we as nurses can do to prevent some of the clotting but sometimes it's unavoidable and Nxstage acts like it's no big deal. ICU patients on CRRT can not tolerate that kind of blood loss AND they say there filter is so large for blood flow up to 600ml/min and for larger volume removal--what ICU/CRRT patient can tolerate 600ml/min blood flow and IF they can handle large amt of volume removed --do a hemo treatment! I'll take the Prisma back anyday!! Most of the problems with Prisma are--I hate to say this, but since I'm on both sides--are user error--the things I see done to that CRRT machine opened my eyes to why I was called in so much. More education is needed and needs to be done by ICU nurses not Gambro/Nxstage sales reps!!!

I agree the nurses need more training, Yes 240 cc would really drop their Hg and then think about the cost of transfusions. I know that yeast grows within 12 hours in the effluent line and that is why we opted not to use the NxStage. I think nursing as a whole has changed and that is scary. I am glad you came to ICU. dialysis does play a huge role in CVVH but often times not all the staff will come in if a circuit goes down.

well, i'm an italian nurse. in our icu, crrt is abitual worked by nurses staff.
assembled and runned by themselves, using Bellco machines. i'm the trainer ad tutor about teaching all the systems. i've a personal program of auto-teaching by clinical cases and courses in multiple hospitals.
any question for me??

What product are you using and are there any issues?
We are currently using prisamflex: Had a lot of issues when we changed from prisma to prismaflex. The machines suddenly malfunctioned- pumps going crazy and the machine had to be taken for service. Gambro has since placed a softwear upgrade and the machines are running great. Only few issues to be fixed w next upgrade. The problem is that NX stage came in and our nurses want to convert. Seems more nursing freindly. The nephrologist do not like this product. They want CVVHDF and NX, braun etc can not offer that currently. In our intensive care units the nurses do it all and the diaylisis dept. has gotten out of it.

Who does the CRRT for infants?? Need ideas for training and education --new nephrologist onboard and need immediate training. Don't want to practice --we have the accura machine. Who does the hemo for babies?? Please help

Hi,

We do about 1-2 CRRT for every 2 - 3 months. Every time dialysis nurse is present in ICU and take care for machine and CRRT procedure. All others around that patient is ICU nurse job.

Is it CRRT ICU or dialysis job?....Hm....

Critical care nursing and dialysis nursing today are highly specialized fields and every improvization is potential risk for patients health/recovery.

I think that dialysis nurse are expert for CRRT and the best solution for patient who is on CRRT is dialysis nurse. Thay do CRRT, dialysis and other similary procedure every day. Thay have expirience, thay have knowleage.

ICU staff who is 1:2 even 1:3 ( in my ICU ) cannot take responsibility for patients safety during the CRRT procedure.

Dear collegues, does anybody know what is in the effluent? What about virusses, medication or yeast and fungi?
Kind regards, 6Eyes, The Netherlands

we use the fresinus K machine with a micro chip. We turn the blood flow to 200, and the dialysate flow to 200 also. We run replacemnt fluids of Ns at 200 ml /hour into the art/venous chambers. Nothing to weigh, measure or calibrate. We just use our standard nicarb, adjust the bicarb on the machine to the drs orders. Usually we use a 4k, 2.5 ca bath with 1meq mg. We use this on adults and babies. We get excellent clearance and all the ICU nurses are responsible for are writing numbers down every hour, and changing the replacement bags as needed. They are taught how to troubleshoot some, and return if the system is clotting. We reset up as needed. I really do like this method --it works well for the pt and is low maintance for the Icu nurse,