To All the Great RNs who answered my Q: "What's CVVH?"

  1. ...I wanted to say, thank you, again...I was the final-semester nursing student in ICU who had to care for this male patient...I just wanted to give you all an update.. 7 weeks in ICU, and this man is still, believe it or not, on CVVH, and on mechanical ventilation. Liver and kidneys went a long time ago - he's been getting PRBCs at 2-3 per DAY for almost ten days...the sternum-to-pubis incision that was opened for peritoneal lavage (sepsis, which was treated and re-emerged as a VRE-superinfection requiring three courses of Zyvox) remains, at almost six weeks post-op, completely without granulation of any kind, and the abdominal contents remain exposed with just a thin sheet of mesh covering. No cognition of any kind, except a little wincing with deep pain. TPN. Two picc lines....Four Jackson-Pratts draining almost 6 weeks. ileostomy....foley....febrile....fails vent weaning day after day. The family just won't let this poor man go (he remains a full code). It's heartbreaking. I didn't mean this to be a downer! All of who that helped me were so kind and generous with your knowledge, and I can tell many of you cared. Thanks again, and everyone have a great evening.
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  2. 5 Comments

  3. by   BBFRN
    Sadly, I saw stuff like this all the time in critical care. Makes you wonder if the guy gets a check that the family is now getting. Get my drift?

    Has there been a palliative care consult done for this poor man? This is just so sad!

    Thanks for the update. Sounds like he may be having a DIC problem. If the mesh is deep in the wound, and is not the kind that is changed like a drsg, it's probably there for grafting.

    I'm glad for him that he has you around.
    Last edit by BBFRN on Oct 25, '07
  4. by   tutored
    Quote from Baptized_By_Fire
    Sadly, I saw stuff like this all the time in critical care. Makes you wonder if the guy gets a check that the family is now getting. Get my drift?

    Has there been a palliative care consult done for this poor man? This is just so sad!

    Thanks for the update. Sounds like he may be having a DIC problem. If the mesh is deep in the wound, and is not the kind that is changed like a drsg, it's probably there for grafting.

    I'm glad for him that he has you around.
    Hi, I remember your screen name!:spin:...the mesh is superficial - the surgeon told me it's just to keep everything moist and contained while granulation was supposed to happen. No DIC, yet, but he's always got a little heparin in him for the CVVH, but no doubt it wouldn't stop a DIC event. Many doctors have ordered hospice consults, but the visiting wife/daughters/sisters won't hear of it. Thanks for your nice words - unfortunately I left my ICU rotation - I was only there again yesterday because I had the priveledge of shadowing the NP in cardiology on her rounds, and she looked in on him.
  5. by   tutored
    Quote from Baptized_By_Fire
    Sadly, I saw stuff like this all the time in critical care. Makes you wonder if the guy gets a check that the family is now getting. Get my drift?

    Has there been a palliative care consult done for this poor man? This is just so sad!

    Thanks for the update. Sounds like he may be having a DIC problem. If the mesh is deep in the wound, and is not the kind that is changed like a drsg, it's probably there for grafting.

    I'm glad for him that he has you around.
    I just now got your drift (didn't have enough coffee today), and I completely agree...the socioeconomics match your drift.
  6. by   BBFRN
    Quote from tutored
    I just now got your drift (didn't have enough coffee today), and I completely agree...the socioeconomics match your drift.
    Awww...that's so sad. They don't know what a good thing palliative care could be for their loved one. I hate to see people keep someone around who is either suffering or has little to no brain activity. Poor guy.

    I hope you had a good learning experience with the cardiology NP. They were a Godsend to us when I worked on the unit.
  7. by   tutored
    Thanks for asking, I loved shadowing the NP for two days...at first she was looked at by many older MDs at this older hospital as something of an oddity, but once they saw just what she does for the cardiologist she works for, how useful and knowledgeable she is, their response was, "Where can I get one?" .." Do you have any colleagues that want to work with me?"....although it took our hospital two years to figure out what to do with her, she is definitely in the groove, and I would love to walk in her shoes someday.

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