[ICUSurg/TraumaRN]

At the hospital where I work, we have one nurse to run the CVVHD and the other to take care of the patient as part of their regular assignment of 2 patients. Not all the nurses are trained in CVVHD, they must take a 2 day class and be checked off before thy are able to do it independently. The nurse running the CVVHD always helps with the patient care, even though technically they only need to run the machine. Sometimes, if we are in a staffing crisis, we will 1:1 the CVVHD patient, but it's very rare.

[chaosRN]

Originally Posted by LolaICUNurse

Our CVVH's are 1:1 ALWAYS. If there isn't enough staff, that means someone else has a 3 patient assignment of hopefully stable patients. We don't even leave the room to go to the bathroom in our unit or talk on the desk unless someone else comes into the room or sits outside the room. For some reason, we are extremely fearful of catheter disconnection and exsanguination in my unit. That seems to be the driving force behind the 1:1 ratio more than hemodynamic instability.

Exactly how we do it. It's not only disconnection and exsanguination we're watching, but also clotting off. CVVH - 1:1

[gizelda]

Always 1:1 sometimes 2 nurses if they are really sick. we use citrate and we use PRISMA. Your unit manager need some info on safe ratios with the sickest of the sick patients. Do research and bring her the studies and Document everything . Also bring the union into it.

[working4aBSN]

We do CVVHD in our unit and usually when the Prisma machine is first initiated the patient is 1:1 for the first four hours then as long as the patient is stable then you can pair the nurse with another patient that is easy and it seems to work out for us. We just recently had a patient that on CVVHD and we are responsible for setting the machine up and running it. He was 1:1 for me for awhile and then I got a tranfer from the floor. Thanks goodnes that patient was one of those transfer where the physician just wants them in the unit to be observed. I thought I would be ok but the patient on CVVHD was so septic that the machine kept clotting off. It was a mess I was there till 9am charting on the transfer from the floor because I never got to it because the machine had to be restarted twice. But truely if the patient is unstable the I believe the CVVHD patient should be one on one.

[savage4x]

We are 1:1 with all patients, although we don't have RT's or nurses aids. Presently have 3 patients on cvvhdf on 7 bedded unit with 7 nurses. Can be difficult when you have a very septic patient on high flow exchanges 6lt+ per hr, You have very much rely on your colleauges who may not be so busy to help out.
I think your manager is wrong to try and give you 2 patients with one requiring RRT.

[gradcare]

In my unit it is standard 1:1 however the shift leader doesn't have a case load so they "ride shotgun" when the filter is being conected. After that unless your patient is unstable you are pretty much on your own though the shift leader usually makes themselves available when you call for help and disconection. Sure it is not only bleeding out you gotta watch though, massive shifts in fluid and electrolyes plus signs that you filter is on the way out so you can return the blood in a timely fasion and not risk your access.

[koyeh]

Our Patients 1:1, This causes staffing shortage. Is anyone doing a call sheet for CRRT? How does it work?

[Maine Critical Care]

Your manager is out of touch with reality. Try a conference with the Risk Manager about leaving that patient without a nurse in the room!! Can you say LIABILITY??

[sunshineCCRN]

Originally Posted by suetje

Jonnygage.. I can't BELIEVE your managers use that amount of nursing resourses for a CVVH pt!!! Incredible! True, these people are often unstable, may also be on pressors, but we never, ever have it more than 1:1, which is the standard throughout the country. Remember, tho, that the reason this standard was implemented was that years ago, the machines were not nearly as good as they are now. And I feel bad for all you folks that are still having to empty bags every 1.5 - 2 hours! Yikes!!! There is a machine out there now that drains itself. If you put that together with an unstable pt., you still have less workload. And don't forget too, that we ought to be basing the assignment on the pt. acuity. If the pt. is a Stable Mable, (and if you're lucky enough to be using the Nxstage machine with no bags to empy) then you really may be able to have 2 pts...one being a rule out MI, or someting simple (fail to wean) and the other a CVVH pt. As for the poor chap that had no inservice on the machine, that is ridiculous too. someone should provide a bit of theory along with machine function for anyone caring for these pts. In my ICU, that is required before you take a pt on CVVH.

I'm having a hard time with your posts, suetje. Most ICU nurses run CVVHD only occasionally. Even if it was all they did, a 10-minute setup is almost impossible, especially if you have to prime twice. Yes, a stable patient with a smoothly-running, minimally-alarming pump may be okay 1:2--but that's assuming *everything* goes as planned without any bumps. And we all know that never happens. When the you-know-what hits the fan, the nurse is liable. Why come down so hard on facilities whose management makes it a top priority for CVVHD patients to be safely cared for?

It's great that you work for NxStage and have publications on CRRT. CRRT might seem easy for you....but for the rest of us without that kind of background, it is a bit more work.

I certainly agree with you on increased education for nurses. I told my manager that after two years of certification, I wanted to re-take the class as a refresher. The answer was "the class is only for nurses new to CRRT"--if I want to take it, I have to do so unpaid. I plan on doing so, but so far no one in my unit to my knowledge has gotten any further education on PRISMA besides their first 3-hour orientation class. Yikes.

[nurse4theplanet]

Is this the same as CRRT?