[shoelace]

Like fairone, I cannot fathom even putting a stable cvvh patient with another. Not all of our nurses are trained for cvvh; what if you're in your other room and the machine alarms? It clots off so easily sometimes.
Not everyone would know what to do.
Otherwise, there is not only bag exchanges once/hour, you have to mix the bags up, ensure adequate supply, give meds, draw labs, treat lab values, provide basic patient care, do calculations, etc. I think to ensure accuracy, these patients should always be 1:1.

[suetje]

We have a standard that all pts. on CRRT are 1:1, but for a more experienced nurse, you may be able to take another admit or pt. if they are lightweight (r/o MI, or stable vascular pt...). But these pts. are often on CRRT because they are the sickest pts...so why would you not single them? If you can do it, it is great.

[zambezi]

In our unit, pt is 1:1. Dialysis RN sets up prisma and get the patient started but after that its' all the primary RN.

[suetje]

Fairone;
I was part of the design team for the Aquarius. It really is a great machine...(of course I am biased!) But I wondered how you liked it?
And for anyone else that uses the Prisma, why is dialysis setting up the machine? It is a super simeple prime and set up (one of the BIG selling points that they push, so why not take the whole set up over in the ICU? It takes no more time than a dressing change. Besides, they are probably billing for their 10 minutes of time setting it up. And come on, we all al busy, but even a co-worker that is not so busy could set it up for you.

[janfrn]

Our peds CVVHD patients are 1:1 as a rule. At the moment, things are very slow in the unit, we don't float and most of us aren't interested in wasting our vacation hours, so our one, long-term CVVHD patient is 2:1. The plan was to switch him to hemodialysis this week, so that'll change everything...

[pghfoxfan]

We are 1:1 with CVVHD and the dialysis nurse sets up and comes back when we clot off. Also with so much HIT lately, we hardly use Heparin anymore, which means more frustration!

[dv8rn]

pghfoxfan,

We've been seeing so much more HIT out here in the west too. What's up with that? Sometimes I really think we're driving ourselves to extinction.

[pghfoxfan]

Originally posted by dv8rn
pghfoxfan,

We've been seeing so much more HIT out here in the west too. What's up with that? Sometimes I really think we're driving ourselves to extinction.

I think HIT was always out there...but
1. We are doing more and more procedures using Heparin(just look at the repeat patients having caths and angioplasties)
2. We never really looked for it...people just had strokes, or dies
3.Many places still dont know about HIT...they just know that there is "white clot"

[Gardengal]

One of the reasons we have dialysis set up the machine is that we do not store it , or the supplies and they bring all the stuff. They are responsible for getting it going for the first hour and making sure that all is going well.
Sure, we are perfectly capable of getting it set up, but usually the decision to start Prisma is one which will require some assignment juggling, and this gives us a little bit of leeway. Just because we could do it doesn't mean we should.
We have in house dialysis staff, and since they do it all the time they can set up a good system for us while we catch up on our other patient in order to spend more ime with the new PRISMA patient, or change assignments

[nurse-lou]

In my unit CVVHD pt's are STRICT 1:1.....
We do it all, set up to tear down. The supplies are in Central Storeroom.