Cvvhd - page 4

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   LT Dave
    Quote from 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.
    Same here at my hosp as Glascow. 1:1 otherwise you are not making all the adjustments in the I&Os. We do it all no dialysis nurse.
  2. by   boynurse2
    Quote from 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.

    The ventilator is pretty easy to set up too. The echmo may not be so bad or the balloon pump. Why don't we just take over everyone's duties? But seriously, nurses have enough responsibilities to add one more machine to set up and troubleshoot. The nurses at my hospital complain sometimes, but we do have it easy for cvvhd patients. We always get 1:1 no matter how stable the patient. We use the Fresenius machine which is a regular HD machine that has been modified to do slow dialysis. It's 100 times better than the Prisma. You don't have to empty the dylisate; a drain tube goes directly into the sink or toilet. Our MD usually just sets the hourly removal rate at a constant after calculating the pt's piggybacks- we just reset the volume q1hr. And unlike the Prisma, you can switch from SCUF to CVVHf or CVVHD without starting over the programming. We attempt to troubleshoot the machine but if we get tired of it then there is an oncall dialysis nurse to fix it over the phone or come in. The dialysis nurse only asks of us to turn the machine off of the patient is about to code to save 1lb of paperwork.
  3. by   boynurse2
    Quote from LindaMarie76
    In our hospital it is always 1:1. In my two + years in critical care, I have never seen it otherwise. Granted, most of the patients on CVVHD or CVVHDF are on vasopressors with Swan Ganzs and are always intubated.

    Linda

    P.S. Does anyone know of a really great inservice program out there? I'd be willing to travel in exchange for some serious education.


    Just ask the company that supplied the machine. ask the hd nurse or the hosp clinical educator.
  4. by   magg_ot2
    Quote from 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"
    can u please explain further what's HIT? thanks..
  5. by   LindaMarie76
    Thanks for the advice. I will be going. I live in South Florida, but I am already off of work that weekend PLUS I will be on spring break from school (I am also a MSN student). Sooo....I will be flying out for a lovely 4 day, 3 night break to San Diego to learn all the ins and outs of CVVHD and become a resource person for the hospital. THANKS!!! :hatparty:

    Linda

    Quote from suetje
    Linda;
    If you can afford the time, you ought to go to the CRRT symposium in March (10 - 12) in San Diego. It is 3 days of all aspects of CRRT, from access, to machines, to research about what is best, nursing issues etc. I wrote a program for Baxter for core CRRT education, and I know the Prisma people had one too. Nxstage also has one. But if you can go to the CRRT meeting, you would REALLY love it! Not only is it beautiful there, but the contect is CRRT and ICU issues. Go to www.crrtonline.com and check it out or search on CRRT.
  6. by   suetje
    Quote from 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).
    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.
  7. by   begalli
    We use Prisma. Our cvvh's are always 1:1.

    Our ratios in the ICU are 1:1 or 1:2 max. If we're talking fractions of nurses though, a 1:1 assignment is always 1 1/4:1 and the 1:2 assignment is always
    1 1/8:2. Always. This is the way our unit is staffed...we use float nurses (staff nurses) who do not have an assignment per se, but float to help out other nurses on the unit and to cover breaks. This does not count the charge nurse who does not have a patient assignment.

    So actually our cvvh's ratio is 1 1/4:1, always.
    Last edit by begalli on Jan 30, '05
  8. by   suetje
    Quote from begalli
    We use Prisma. Our cvvh's are always 1:1.

    Our ratios in the ICU are 1:1 or 1:2 max. If we're talking fractions of nurses though, a 1:1 assignment is always 1 1/4:1 and the 1:2 assignment is always
    1 1/8:2. Always. This is the way our unit is staffed...we use float nurses (staff nurses) who do not have an assignment per se, but float to help out other nurses on the unit and to cover breaks. This does not count the charge nurse who does not have a patient assignment.

    So actually our cvvh's ratio is 1 1/4:1, always.
    All I can say is you guys must have a great surplus of nurses! We have a charge RN who also (on days) does not have an assignment, but otherwise, we do not have anyone else who could assist. You are lucky!
  9. by   DeniseRNBSN
    Quote from begalli
    We use Prisma. Our cvvh's are always 1:1.

    Our ratios in the ICU are 1:1 or 1:2 max. If we're talking fractions of nurses though, a 1:1 assignment is always 1 1/4:1 and the 1:2 assignment is always
    1 1/8:2. Always. This is the way our unit is staffed...we use float nurses (staff nurses) who do not have an assignment per se, but float to help out other nurses on the unit and to cover breaks. This does not count the charge nurse who does not have a patient assignment.

    So actually our cvvh's ratio is 1 1/4:1, always.
    We use the Prisma also which is very easy to set up.

    Our CVVHD patient's are 1:1 for the duration.

    Denise RN, BSN, CCRN
  10. by   begalli
    Quote from suetje
    You are lucky!
    Believe me, after finding this board and reading what it's like for a majority (it seems) of RN's, I KNOW I'm lucky. Or is it that this hospital has great management, an open supportive dialouge with staff, and really is patient and employee oriented? A good union doesn't hurt either.

    It should be like this everywhere!

    I really really really wish ALL nurses could feel the satisfaction I feel in my job and my employer. Sometimes I feel bad posting such positive comments when everyone else seems to be suffering. :uhoh21:
  11. by   Linda Ng
    Anyone out there has the manual or know-how on the Aquarius machine? I am used to Prisma and the ICU I am working in has acquired 2 new Aquarius machine which the NM is pushing all of us to use. I would appreciate of anyone can tell me the advantages of it over Prisma, and also how user friendly it it. Thanks!!
  12. by   Linda Ng
    Can anyone out there tell me more about the Aquarius? I am used to Prisma,but very new to the Aquarius. I would like to know the advantages of Aquarius over Prisma, what are the added features of Aquarius and how user friendly the Aquarius is. Thank you...
  13. by   kmvel
    1:1 Is The Only Safe Way. Are You Kidding Me. If Your Manager Does Not Want A Really Bad Patient Outcome, She'll Uphold The Policy Of Cvvh Patients Being 1:1.

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