What's "CVVH" in the ICU??

[tutored]

Can someone please help me out? I am a final-semester nursing student starting ICU tomorrow - I have a patient on "CVVH", and though I have many fine medical books, a big PDA, and lots of resources, I can't for the life of me decipher the letters. I have to present this patient tomorrow morning. Can someone throw me a bone and tell me what the initials stand for, so I can look up the treatment? Thanks so much, any help would be wonderful.

[Diary/Dairy, RN]

Yeah, I can, thanks to everyone else for telling me what it is! It's a continuous filtration of the venous blood, through a large vein (my patient's tap is near the subclavian), mainly for patients who can't handle any insults to their hemodynamic stability and therefore aren't candidates for dialysis. My patient is septic on top of everything else wrong (mechanical ventilator, peritonitis with abdominal abscess, heart failure, acute renal failure), so the last thing he needs would be "another" opening into the body! It sure seems like he's toast. Add IV fentanyl, versed, and a muscle relaxant, TOGETHER!!! He's been in for 3-1/2 weeks. I was scared earlier today to start caring for him, but the pep talk from everyone has me excited to learn. Thanks again, everyone!

Sounds like one fun patient to me - I LOVE the sickies when I can just focus on them - I am working tele now and I miss my vents/balloon pumps/CVVH all that good stuff!!

[cmo421]

If any of the four kind RNs who responded to my plea for help and info yesterday - thanks again! Today went well, though I felt a lump in my throat when I first went in and saw the CVVH machine with a huge double-lumen line coming out of the subclavian, plus two picc lines, each triple lumen with SEVEN concurrent IV drips, foley draining the worst-colored urine I've ever seen, mechanical ventilation, septic beyond belief, and for flavor, a COMPLETELY OPEN abdominal cavity, with a incision from xiphoid to pelvis, covered only with what looked like a sheet of plastic wrap over it (waiting for preliminary closure in the OR), with four JP drains in various areas. You were all right - he was truly a sick man - I'm assigned to him tomorrow, but I'm afraid he won't survive the OR this afternoon. Thanks again, all of you!

my kind of pt, I am jealous,,,,lol . You will learn lots from this one.

[palkie]

original post:

if any of the four kind rns who responded to my plea for help and info yesterday - thanks again! today went well, though i felt a lump in my throat when i first went in and saw the cvvh machine with a huge double-lumen line coming out of the subclavian, plus two picc lines, each triple lumen with seven concurrent iv drips, foley draining the worst-colored urine i've ever seen, mechanical ventilation, septic beyond belief, and for flavor, a completely open abdominal cavity, with a incision from xiphoid to pelvis, covered only with what looked like a sheet of plastic wrap over it (waiting for preliminary closure in the or), with four jp drains in various areas. you were all right - he was truly a sick man - i'm assigned to him tomorrow, but i'm afraid he won't survive the or this afternoon. thanks again, all of you!

tutored, are you sure you are not in the trauma unit i used to work in?? seriously, i thought we were the only ones with transparent abdomens - or "guts hanging out" as i like to call it -usually gunshot wounds to the abdomen.

sorry, i realize i sound like one of those old 'hard' uncaring nurses. i'm really not - it's a defense mechanism that builds over the years.

i really hope your patient can turn a corner and get better, or if not, at least die with dignity and no suffering. and my heart goes out to you as a new nurse dealing with all this for the first time. try not to be overwhelmed, but y'know, it's ok if you are - even very seasoned nurses can be intimidated or worn down by very sick patients.

i commend you for sticking with this patient, and for caring, but i would also say take care of yourself and don't feel guilty if you need a break from this super-sick one and need to switch patients for a couple of days.

again, good luck to you and to your patient and his family.

[tutored]

tutored, are you sure you are not in the trauma unit i used to work in?? seriously, i thought we were the only ones with transparent abdomens - or "guts hanging out" as i like to call it -usually gunshot wounds to the abdomen.

sorry, i realize i sound like one of those old 'hard' uncaring nurses. i'm really not - it's a defense mechanism that builds over the years.

i really hope your patient can turn a corner and get better, or if not, at least die with dignity and no suffering. and my heart goes out to you as a new nurse dealing with all this for the first time. try not to be overwhelmed, but y'know, it's ok if you are - even very seasoned nurses can be intimidated or worn down by very sick patients.

i commend you for sticking with this patient, and for caring, but i would also say take care of yourself and don't feel guilty if you need a break from this super-sick one and need to switch patients for a couple of days.

again, good luck to you and to your patient and his family.

hi palkie! i am, in fact, a student nurse, in my final semester. so, i guess this would be much more overwhelming if this was my patient. i would love to be a trauma nurse! good advice on taking care of myself - we don't take lunch breaks here in the icu, and this is a bad habit i have to break....

.....as for the patient update, he did survive the or, his abdomen is still open from sternum to pelvis, but with a few montgomery straps holding lightly. skin breakdown all over the place, but not from pressure ulcers - these were broken blisters from extreme edema. now, his liver is finally starting to show the effects of so many iv meds, and to top it all off, they've identified vre superinfection in the peritoneal fluid, so a 5th antibiotic, the biggest of them all (zyvox) has been added. it's painful to see this kind of struggle. he's still paralyzed on the veconium.