[gwenith]

Originally posted by pghfoxfan
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"

By Hit I gather you are refering to Heparin Induced Thrombocytopenia Syndrome but "white clot"? Please for the sake of my curiosity elaborate!!!

[suetje]

I think heparin is going to go the way of the do-do bird...the platelets are gone it seems pretty quick and HIT is almost a given. How many of you guys have considered using citrate? It makes the circuit last foever, and you can use a simple protocol for labs and titating the calcium. I really think to get the most bang for your buck (considering the cost of CRRT circuits!) citrate is the best cost- effective response. We switched from no heparin, or a little to citrate about a year ago and WOW! What a difference!

[janfrn]

We only use citrate. It sure is a lot easier than heparin. We have a protocol for titrating citrate/CaCl according to the circuit/serum ionized calcium levels on our gases. Sometimes our docs will order patient-specific adjustments. We have no bleeding issues and the filter rarely clots off, unless it's running on a small infant. We do however, use heparin (5000u/L) for our initial prime as it removes more of the manufacturing debris from the circuit, then just before connecting to the patient we reprime with NS. Works great.

[suetje]

We have been using 1:1staffing for our CVVH pts, but are now re-thinking it. As mentioned, these pts. are usually the sickest, so that makes sense. But sometimes they are stable-mables, and you could take a rule out MI or a carotid if it was uncomplicated. AND if they were nearby. (Got to be able to hear the alarms and know they are from your machine!)

Most people say that putting in the numbers for fluid calcs takes time, but it only takes a minute or so. It is the hauling of the drain bags that is the work!!! The company I now work for has a no drain bag system, and you can hang multiple fluid bags at once and then forget about them for hours (as in, 12Liters or more!). So if you eliminate that time-comsuming variable, you do not have so much work. Not to mention the machine is super simple, the troubleshooting is on the screen and NO BAGS!!!

Also, the alarms are such that you can choose the type of alarm you can hear (set the volume!) and make them different than your other machines in the room. FYI, the Aquarius is a nice machine, Edwards has worked out a lot of the software issues in it, but there are still several 5 liter bags to haul to the dirty room every couple of hours. If you don't mind that....

[Bruno Matos]

In my unit (CT surgery), we use PRISMA (CVVHDF) a lot of times. Usually those patients have inotropic support, are haemodynamic unstable, ventilated... We make the initial setup, the priming and all additional settings. The ratio it´s 1:1.

[nurse-lou]

Pt's on CVVHD in our unit are SUPPOSED to be 1:1 but due to our tight (read short) staffing sometimes they are 1:2! I think this is ridiculous but then again in my unit we frequently have 3 pt assignments. If someone calls in sick, we're in trouble. I work straight night shift and 3 pt assignments are the norm rather than the exception.

[CARDIACSURGICU-RN]

We Are Mostly Doubled With Patients Like This (meaning 2patients To One Rn, Occasionally We Will Receive Ancillary Support, I.e. Technician) It Is Not Uncommon That We Have A Fresh Post-op And A Patient On Vasoactives And Cvvhd Or Any Other Form Off Crrt.

[suetje]

Originally Posted by nurse-lou

Pt's on CVVHD in our unit are SUPPOSED to be 1:1 but due to our tight (read short) staffing sometimes they are 1:2! I think this is ridiculous but then again in my unit we frequently have 3 pt assignments. If someone calls in sick, we're in trouble. I work straight night shift and 3 pt assignments are the norm rather than the exception.

Nurse Lou, ...all the more reason to have a machine with LESS worklload!!! If you have a bad access, it is a bad day no matter what equipment you have. But if you don't have to hang and drain bags, you can work with the PATIENT, NOT the machine!!!

[heart queen]

I wouldn't say that its the cvvhd that makes these guys 1:1's. In our unit it's all the other hoopla of instability, maxed on drips... you bring the crash cart into the room to do a code brown, look at them for a second too long and their pressure is in the toilet that makes them cvvhd, not HD.

Reminds me of when IABP's were 1:1 mandated, until we saw sicker and sicker patients, and it was suddenly "doable" to pair a pump with the most stable r/o MI, then the next day it seemed you had a vent with a pump... then the manager says... well this pump is stable and you're weaning him... let's pair him with the other pump...

I think a huge part of this is that slippery slope where once we become more skilled in our time management with sicker and sicker patients.. we're asked to take on more and more... Until what was considered obscenely unsafe a year ago is now common practice. You look back and think how the heck did this happen?

It makes you wonder why nursing school requirements now don't mandate that you have 4 extra arms surgically implanted to be able to handle the workload. Meanwhile administration has the aerosol valium spray that dispenses Q5 minutes to keep the staff "happy".

Sorry, diving off topic here rapidly. I REALLY sense your concern... Where will this STOP? How much more can we do and provide the care that we need to give. There are SO many patients that need to be 1:1's and are not.

I'M WITH YOU! Sick enough for cvvhd, you're a 1:1 until the Hd nurse shows up for regular dialysis.

Again sorry for the rant and rave

[CCU NRS]

1:1 here and also IABP still 1:1 please don't mention all you are doing to the managment here! LOL I am sure it is only a matter of time until they try just what you mention, Heart Queen