Cvvhd - page 6

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   gradcare
    In my unit it is standard 1:1 however the shift leader doesn't have a case load so they "ride shotgun" when the filter is being conected. After that unless your patient is unstable you are pretty much on your own though the shift leader usually makes themselves available when you call for help and disconection. Sure it is not only bleeding out you gotta watch though, massive shifts in fluid and electrolyes plus signs that you filter is on the way out so you can return the blood in a timely fasion and not risk your access.
  2. by   koyeh
    Our Patients 1:1, This causes staffing shortage. Is anyone doing a call sheet for CRRT? How does it work?
  3. by   Maine Critical Care
    Your manager is out of touch with reality. Try a conference with the Risk Manager about leaving that patient without a nurse in the room!! Can you say LIABILITY??
  4. by   sunshineCCRN
    Quote from suetje
    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.
    I'm having a hard time with your posts, suetje. Most ICU nurses run CVVHD only occasionally. Even if it was all they did, a 10-minute setup is almost impossible, especially if you have to prime twice. Yes, a stable patient with a smoothly-running, minimally-alarming pump may be okay 1:2--but that's assuming *everything* goes as planned without any bumps. And we all know that never happens. When the you-know-what hits the fan, the nurse is liable. Why come down so hard on facilities whose management makes it a top priority for CVVHD patients to be safely cared for?

    It's great that you work for NxStage and have publications on CRRT. CRRT might seem easy for you....but for the rest of us without that kind of background, it is a bit more work.

    I certainly agree with you on increased education for nurses. I told my manager that after two years of certification, I wanted to re-take the class as a refresher. The answer was "the class is only for nurses new to CRRT"--if I want to take it, I have to do so unpaid. I plan on doing so, but so far no one in my unit to my knowledge has gotten any further education on PRISMA besides their first 3-hour orientation class. Yikes.
    Last edit by sunshineCCRN on Oct 17, '06
  5. by   nurse4theplanet
    Is this the same as CRRT?
  6. by   sunshineCCRN
    Quote from asoldierswife05
    Is this the same as CRRT?
    CRRT is any continuous renal replacement therapy, and could mean CVVH, SCUF, CVVHD, CVVHDF, etc.

    Someone correct me if I'm wrong.
  7. by   rnccrn96
    I've read all the posts on this thread and would like to add a couple of observations. I've worked with this therapy for over 10 years and think it is a very important tool. First, CRRT is to the kidney what a balloon pump is to the heart. A bridge to mimic the function of an organ that is either too sick or too overwhelmed to do its job effectively. An organ that needs a rest. IHD and dialysis nurses deal with a large amount of fluid taken off over a small amount of time. Their patients are usually ARF and ESRD patients who have lost the function of the native kidneys. Many are not comfortable with CRRT. CRRT is used to try and preserve the native function in an otherwise compromised patient e.g. sepsis, ARDS, etc. As to staffing ratios for these patients: Most hospitals, including mine are 1:1. I have worked in hospitals where the patient is stable enough to take a second, low acuity patient. As to systems, there are several out there and I have either trialed are used them all. I've read a lot about emptying bags, drains etc. You must ask yourself that as a nurse what is most important to you? Lessening your workload or your patient outcome? Those systems that have bags and scales give me piece of mind that a drained system doesn"t. It allows me, through simple calculation, to see what is in the bag against what the machine is set up to take off. A drain does not. It's gone. You must trust that the system did exactly what it should have. What if there's a glitch in the software? How would I even know? Am I willing to put my patient at risk just so I don't have to empty a bag every couple of hours? I know that I don't trust IV pumps to calculate a constant on vasoactive gtts without checking that calculation manually. Check systems are a good thing and necessary for patient safety. Second, those systems that use bags are closed systems, read sterile. In an ICU with an already severely compromised patient why would I even think about risking a secondary path for opportunistic organisms?? An open drain in to a sink or toilet?? I don't think so. My goal as an ICU nurse is to give my patients every opportunity to make a full or as near full recovery as possible. CRRT conference San Diego: Go if you can! A great conference to learn, network and see what's out there. My hospital sends two RN's from every ICU each year. Training: Most manufacturers offer free training. Some are better than others. Ask for what you need to feel comfortable and competent with your hospitals equipment.
  8. by   trebor1
    In my ICU, CRRT and all other "dialysis things" are dialysis nurse job. During the whole procedure they are near the machine and take care for CRRT/dialyisis. We ( icu nurse ) take care for all others around the patients
  9. by   tde1992
    I work in a large teaching hospital of a 30 bed ICU. Our patients are always 1:1 during CVVHD, CVVH etc.
    Last edit by tde1992 on Nov 25, '06
  10. by   K98
    Always 1:1
  11. by   AJACKSON1048
    We are also 2:1 for the first four hours and then the second nurse only takes a stable patient so they are available if needed. We do all setup and touble shooting and if we need to end tx fast then the second nurse comes back and someone else takes her/his pt.
  12. by   honeyb61
    We, keep them 1:1. You set it up, chg the dialysis bags, draw labs and send, tit drips and adm. lyte replacements, and basic pt care. Not to include constantly calling pharm so that your fluids will not run out!
  13. by   RN Randy
    Wow... must be nice. I'm 3 months into the job and we're so understaffed I've already taken a couple of CRRT patients 1:1, and was scheduled for a second pt the next night; but had the good luck of a filter clot a couple hours before my shift started. Fortunately for me, it was a weekend, and the ologist decided to let the pt ride on his own for a night. [??] Experienced nurses tell me I should be able to do it 1:2 and they take CRRT and another patient routinely.
    [I'd love to see our filter-clot numbers.]
    It's mostly my shift; the other shift takes it more seriously. [We've got a 'shift of individuals problem' coupled with a 'shouldn't be a nurse' problem, with no cure in sight.] We do everything but the filter change, and scuttlebutt says as soon as the hospital/dialysis contract expires, we will purchase the machines and do the filters too.

    We've also started hiring LPN's to fill the gaps.... assign one RN and one LPN to 3 patients... ? As for CRRT, the LPN's were in the class with me and will almost be able to do everything except d/c treatment, change the removal rate and restart the citrate/calcium should it be turned off.


    rb

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