CRRT: Who does it??

  1. 0
    I am a dialysis nurse working in an inpatient, acute care setting. Where I work, the dialysis staff sets up the CRRT (PRISMA), provides teaching to the critical care staff, changes the set-up when the sytem clots, makes the changes when there is a change in modality ordered (ie: SCUF to CVVHD), on call for problems, and discontinues the treatment when so ordered. Please tell me how it is handled where you work. I would also like to know what area you work in (ie: ICU, CCU, SICU, TICU, CVRR, Dialysis, etc.) and how you feel about your CRRT resonsibilities. Thanks in advance.
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  4. 29 Comments so far...

  5. 0
    What we do is exactly what you are doing in your hospital. But there is always conflicts between ICU staff and dialysis nurses when it comes to this question. Some nurses will be very happy to take up the responsibility while some nurses don't. We all know that it is impossible for us to stay in ICU and monitor the patient and the machine round the clock. ICU staff has to do it. A clear hospital policies on who does what will help to prevent conflicts.
  6. 0
    We do everything ourselves, with minimal backup. The ICU nurses in our TSICU (trauma/surg/burn) and MICU takke classes on prisma and from then on run the therapy and do all of the things you mention. Matter of fact, the MICU stores the prisma machines when not in use. We are responsible for orderingour own supplies and dealing with the renal docotors. Our patinets are usually only made one to one when stable, but if they are on high dose pressors, then they are two to ones.
  7. 0
    one other thing to add, pharmacy mixes all the dialysate, and replacement fluids.
    Last edit by nilepoc on Oct 12, '01
  8. 0
    In the CVICU where I work, the nurses do everything with the CRRT. But first you have to attend inservice classes, and then your name goes on the list of nurses in the unit who can do CRRT. (We do the same for IABP and VADs.) If we have problems we can't handle, which is a rare occurence, we call the Prisma rep. We always nurse the patients 1:1. When we first started using the Prisma, in the early 90's, we would have 2:1, but that didn't last long!!! If and when the patient is stable enough for hemo, the dialysis nurses take over, and bring their portable equipment, which we have nothing whatsoever to do with.
  9. 0
    The nurses in my ICU who've been trained in CRRT with the Prisma machine, set up and all that other Jazz with the machines. Pharmacy sends up KCL to inject into the dialysate. I've not been trained on it yet...probably within the next 6 months or so....
  10. 0
    I work acute HD and thank god we don't do CRRT, for the reasons mentioned above. We are contract workers and it always ends up in a big mess about who is supposed to do what, even with a clear hospital policy. Doctors don't know/care what hospital policy is. They ask us to do all kinds of things that we aren't "credentialed" to do at our hospitals. I hate having to explain this to a nurse, especially when we tell them that they have to come to the unit to check BG'S. We do not even have a BG monitor!! all we are "credentialed" to do is dialysis and dialysis related procedures. We aren't even supposed to suction a pt in ICU when we are doing a treatment!! Ya know that us good nurses do it anyway!!!

    p.s. Our docs don't like CRRT. They have the mindset that if the ICU pts cant tolerate a slow, gentle HD, they don't need CRRT.
  11. 0
    Hi

    You say "first you have to attend inservice classes." Can you tell me about your training regimen? How many sessions do you get? How many hours per session? An overview of what comprises the training? Have you heard of any incidents resulting from insufficient training?

    We have one 4-hour session for ICU indivual CRRT dialysis.

    Thanks.

    Nancy
    :uhoh21:
  12. 0
    my colleagues and I don't have any conflict with ICU staff as our roles a fairly clear. Long term patients that the Renal Unit hs not seen or heard of are generally looked after by the ICU staff and are dialysed on CVVHD. Personally I have no idea what a CVVHD looks like! One of us renal nurses is on call, after hours 356 days a year. If a patient in ICU needs acute dialysis then we wil be called in and will perform dialysis in ICU.
    If a patient crops up on a Sunday (the only day the dialysis unit is closed) we will still have to dialyse the patient in ICU, as we need expert nursing help around in case the s**t hits the fan.
    My ICU colleagues are nothing but helpful in the times i have had to "encroach" on their turf to do my job. Their machines scare the hell out of me and my machine scares the hell out of them!!
  13. 0
    Dear neph:
    I also work in an acute setting where we have one Prisma machine. We have had numerous problems with it (computer wasn't functioning correctly, etc)
    which clotted the catheter where we couldn't give them their blood back.
    The nurses in the units were very reluctant to attempt to run them after we went home on call.
    WHERE do you give the Calcium chloride back if you use citrate as a anticoagulant? We have a Quinton with a third port and was told by the Prisma inservice personnel to put the Calcium chloride there; but when I called the help desk about multiple clotting (which was the machine by the way)
    I was told that this is not recommended.
    VERY frustrating. NEED MORE INSERVICES. These are slow in coming from the gambro company
    Sherryg


    Quote from NephRN
    I am a dialysis nurse working in an inpatient, acute care setting. Where I work, the dialysis staff sets up the CRRT (PRISMA), provides teaching to the critical care staff, changes the set-up when the sytem clots, makes the changes when there is a change in modality ordered (ie: SCUF to CVVHD), on call for problems, and discontinues the treatment when so ordered. Please tell me how it is handled where you work. I would also like to know what area you work in (ie: ICU, CCU, SICU, TICU, CVRR, Dialysis, etc.) and how you feel about your CRRT resonsibilities. Thanks in advance.


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