Cvvhd - page 5

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   TennRN2004
    Quote from 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?
    Very very rarely, maybe once or twice do to call ins and staffing issues have our CVVHDs not been 1:1. There is no way it is safe to take on another patient. With all the labwork you have to do, much less controlling your flow rates to keep a pressure, if the machine alarms, and you're in another room, it is asking for trouble. There is so much to stay on top of with these type patients, you don't need the distraction of another patient on top of it. If something goes wrong or gets missed, the docs are going to care that you had another patient, there will be no excuse in their minds. I would let the manager know when he/she can take a CVVHD patient with another patient and competently, safely give care to both at once, then consider changing your policy to make a continuous dialysis patient safe enough to take another assignment. Patient safely should be paramount over staffing, budget, etc. What is your manager's rationale for doing it? It can't be in the best interest of the patient.
  2. by   NotReady4PrimeTime
    I'd just really be happy to have a manager who only makes assignments that she would be willing to carry herself. CVVHD definitely must be 1:1.
  3. by   LolaICUNurse
    Our CVVH's are 1:1 ALWAYS. If there isn't enough staff, that means someone else has a 3 patient assignment of hopefully stable patients. We don't even leave the room to go to the bathroom in our unit or talk on the desk unless someone else comes into the room or sits outside the room. For some reason, we are extremely fearful of catheter disconnection and exsanguination in my unit. That seems to be the driving force behind the 1:1 ratio more than hemodynamic instability.
  4. by   twiceaslucky
    We're 1:1 here too.
  5. by   jasper_x
    Quote from 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...
    Aquarius is much (much) cheaper than a Prisma to buy and their artificial kidneys seem to last longer. It's a good unit IMHO, but a little over-sensitive and occassionally has niggly issues, failing it's self test when turning on repeatedly, then passing once a biomed comes to check it out. Tries a little too hard to be user friendly, the software could use some improving.

    The Prisma is a good, reliable work horse. Much easier to load a set (on the Aquarius, all the loading and unloading of the tubing and kidney is all done manually). The arrangement for the Prisma set is very neat and tidy and it's easy to see what's what, where the Aquarius looks like a spaghetti arrangement when it is in full swing.

    Biggest problem with both of them? Lifting heavy bags full of fluid onto the anchor points beneath the units. There must be an easier way....

    Functionally, they pretty much do the same things. Not much between them. Given a choice between them I think I'd choose a Prisma, but the cost of the Edwards unit, and the life of the kidneys, is very appealing.
  6. by   mzcat
    Our CRRT pt.s are always 1:1. We are a very team oriented on our unit and help out with priming and starting the machine for the nurse who is taking the patient and is not very experienced with the machine.
  7. by   nsmith_rn
    yeah we do that..... and it is absurd to think that this would not be a 1:1 pt ratio..... have someone go down the tubes on you when you are running the circuit or better yet when they have ICU psychosis and the institution that you work in has gone restraint free.... and they pull it apart and bleed themselves.....
    Two Words
    SAFE HARBOR
  8. by   lake living
    Quote from 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...
    I know that the Prisma and Aquarius are the same price but the Aquarius has the dialysate and replacement lines together so they have to be the same solution, you have to put the pieces together. It is bulky. It has higher rates than the Prisma. I like the Prisma becasue it is easier. I heard you can' get the Aquarius. Good luck
  9. by   ICUSurg/TraumaRN
    At the hospital where I work, we have one nurse to run the CVVHD and the other to take care of the patient as part of their regular assignment of 2 patients. Not all the nurses are trained in CVVHD, they must take a 2 day class and be checked off before thy are able to do it independently. The nurse running the CVVHD always helps with the patient care, even though technically they only need to run the machine. Sometimes, if we are in a staffing crisis, we will 1:1 the CVVHD patient, but it's very rare.
  10. by   chaosRN
    Quote from LolaICUNurse
    Our CVVH's are 1:1 ALWAYS. If there isn't enough staff, that means someone else has a 3 patient assignment of hopefully stable patients. We don't even leave the room to go to the bathroom in our unit or talk on the desk unless someone else comes into the room or sits outside the room. For some reason, we are extremely fearful of catheter disconnection and exsanguination in my unit. That seems to be the driving force behind the 1:1 ratio more than hemodynamic instability.

    :yeahthat: Exactly how we do it. It's not only disconnection and exsanguination we're watching, but also clotting off. CVVH - 1:1
  11. by   gizelda196
    Always 1:1 sometimes 2 nurses if they are really sick. we use citrate and we use PRISMA. Your unit manager need some info on safe ratios with the sickest of the sick patients. Do research and bring her the studies and Document everything . Also bring the union into it.
  12. by   working4aBSN
    We do CVVHD in our unit and usually when the Prisma machine is first initiated the patient is 1:1 for the first four hours then as long as the patient is stable then you can pair the nurse with another patient that is easy and it seems to work out for us. We just recently had a patient that on CVVHD and we are responsible for setting the machine up and running it. He was 1:1 for me for awhile and then I got a tranfer from the floor. Thanks goodnes that patient was one of those transfer where the physician just wants them in the unit to be observed. I thought I would be ok but the patient on CVVHD was so septic that the machine kept clotting off. It was a mess I was there till 9am charting on the transfer from the floor because I never got to it because the machine had to be restarted twice. But truely if the patient is unstable the I believe the CVVHD patient should be one on one.
  13. by   savage4x
    We are 1:1 with all patients, although we don't have RT's or nurses aids. Presently have 3 patients on cvvhdf on 7 bedded unit with 7 nurses. Can be difficult when you have a very septic patient on high flow exchanges 6lt+ per hr, You have very much rely on your colleauges who may not be so busy to help out.
    I think your manager is wrong to try and give you 2 patients with one requiring RRT.

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