[dv8rn]

Our manager is trying to convince us that a patient on CVVHD is not a 1:1 patient. This therapy requiers constant monitoring and calculation changes. Usually they are not very stable, or they could have regular dialysis. Are any of you doing this in your ICU's? Are they 1:1?

[glascow]

We do it in our unit. They are 1:1. We are trained on the machine and set it up, monitor and assess the patient, dialysis nurse is not involved.

[dv8rn]

We've had one inservice on the machine. The tech comes and sets up the machine, and leaves. After that, we're on our own.

[JohnnyGage]

We set up and run the machine in its entirety. Our patients are always 2:1 for at least four hours. We have found that during the time of set up and initiation, it is good to have 2 nurses -- one to manage the patient and the other simply to act as a dialysis nurse.

If all is stable then the ratio switches to 1.5:1, with the second nurse having another stable patient. One nurse runs the machine, the other purely takes care of the patient. If things are going well, the dialysis nurse certainly participates in patient care, but if the poop hits the blade, each has his or her own duties -- well defined.

The only time we do a pure 1:1 is if the patient is on no drips and is otherwise completely stable (rare).

[dv8rn]

You have 2 nurses to one CVVHD patient for 4 hours and our manager wants us to have 2 patients to one nurse and one is the CVVHD. hmmmm, whats wrong with this picture?

[gwenith]

We have one to one unless the patient is unusually stable and there have been no other problems. We don't actually have a dialysis unit in our hospital so we get the occasional "acute on chronic" who is unventilated and just (just?) requires CVVHD. But we also most commonly do CVVHDF with dialysate counter current and that means bag exchanges on average every hour or two. Add in monitoring electrolytes and adding additives to dialysate as well as PT care issues and you definitely have enough to do.

[Gardengal]

Many times our cvvhd patients are 1:1 but it is usually because of their instability in the first place, not necessarily the continuous dialysis. Since we switched from the BM11 machine a few years ago to the PRISMA we have found that there is really no need once it is set up.
The dialysis nurses set up the machine, although routine trouble shooting and stopping if it's clogging or clotting is our responsibility. Usually th efirst shift they are on Prisma they are singled, but if we aren't titrating drips and only doingthe Prisma maintenance with the hourly I&O and reset of machine there is no reason to single the patient. We try not to double with an isolation or unstable patient though.

[glascow]

I originally posted that we leave these pts 1:1. Last night, we didn't have enough staff to do that so the nurse ended up having to take an admit (stable acute MI post PTCA).

[New CCU RN]

We keep them 1:1... however, we do not staff for this, so when we have a patient requiring it, we have to call in extra help...sometimes we are in a pinch and we either have to triple or give the nurse with CVVH a very stable patient....

[fairone]

Absolutely 1:1. The patients that usually require filtering (CVVDHF) in our unit are the unstable, inotrope dependant, ventilated patients and filtering these patients can further potentiate their haemodynamic instablity. We also setup, manage and troubleshoot the filter. How it could even possibily be considered that a patient like this could be 1:2 is beyond me and I would out right refuse to take another patient.

Additionally, despite the stability of patient, those who require filtering are always 1:1. Anyone using the Edwards Life- Sciences Aquarius? We've recently bought this for our unit after a long awaited upgrade. Just curious to know if other units are happy with this machine or any consistent problems with it? Thanks.