Cvvhd - page 2

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... Read More

  1. by   suetje
    Fairone;
    I was part of the design team for the Aquarius. It really is a great machine...(of course I am biased!) But I wondered how you liked it?
    And for anyone else that uses the Prisma, why is dialysis setting up the machine? It is a super simeple prime and set up (one of the BIG selling points that they push, so why not take the whole set up over in the ICU? It takes no more time than a dressing change. Besides, they are probably billing for their 10 minutes of time setting it up. And come on, we all al busy, but even a co-worker that is not so busy could set it up for you.
  2. by   NotReady4PrimeTime
    Our peds CVVHD patients are 1:1 as a rule. At the moment, things are very slow in the unit, we don't float and most of us aren't interested in wasting our vacation hours, so our one, long-term CVVHD patient is 2:1. The plan was to switch him to hemodialysis this week, so that'll change everything...
  3. by   pghfoxfan
    We are 1:1 with CVVHD and the dialysis nurse sets up and comes back when we clot off. Also with so much HIT lately, we hardly use Heparin anymore, which means more frustration!
  4. by   dv8rn
    pghfoxfan,

    We've been seeing so much more HIT out here in the west too. What's up with that? Sometimes I really think we're driving ourselves to extinction.
  5. by   pghfoxfan
    Originally posted by dv8rn
    pghfoxfan,

    We've been seeing so much more HIT out here in the west too. What's up with that? Sometimes I really think we're driving ourselves to extinction.

    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"
  6. by   Gardengal
    One of the reasons we have dialysis set up the machine is that we do not store it , or the supplies and they bring all the stuff. They are responsible for getting it going for the first hour and making sure that all is going well.
    Sure, we are perfectly capable of getting it set up, but usually the decision to start Prisma is one which will require some assignment juggling, and this gives us a little bit of leeway. Just because we could do it doesn't mean we should.
    We have in house dialysis staff, and since they do it all the time they can set up a good system for us while we catch up on our other patient in order to spend more ime with the new PRISMA patient, or change assignments
  7. by   RNforLongTime
    In my unit CVVHD pt's are STRICT 1:1.....
    We do it all, set up to tear down. The supplies are in Central Storeroom.
  8. by   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!!!
  9. by   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!
  10. by   NotReady4PrimeTime
    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.
  11. by   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....
  12. by   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 its 1:1.
  13. by   RNforLongTime
    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.

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