Cvvhd

  1. 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?
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  2. 85 Comments

  3. by   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.
  4. by   dv8rn
    We've had one inservice on the machine. The tech comes and sets up the machine, and leaves. After that, we're on our own.
  5. by   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).
    Last edit by JohnnyGage on Aug 3, '03
  6. by   dv8rn
    You have 2 nurses to one CVVHD patient for 4 hours and our manager wants us to have 2 patients to one nurse and one is the CVVHD. hmmmm, whats wrong with this picture?
  7. by   gwenith
    We have one to one unless the patient is unusually stable and there have been no other problems. We don't actually have a dialysis unit in our hospital so we get the occasional "acute on chronic" who is unventilated and just (just?) requires CVVHD. But we also most commonly do CVVHDF with dialysate counter current and that means bag exchanges on average every hour or two. Add in monitoring electrolytes and adding additives to dialysate as well as PT care issues and you definitely have enough to do.
  8. by   Gardengal
    Many times our cvvhd patients are 1:1 but it is usually because of their instability in the first place, not necessarily the continuous dialysis. Since we switched from the BM11 machine a few years ago to the PRISMA we have found that there is really no need once it is set up.
    The dialysis nurses set up the machine, although routine trouble shooting and stopping if it's clogging or clotting is our responsibility. Usually th efirst shift they are on Prisma they are singled, but if we aren't titrating drips and only doingthe Prisma maintenance with the hourly I&O and reset of machine there is no reason to single the patient. We try not to double with an isolation or unstable patient though.
  9. by   glascow
    I originally posted that we leave these pts 1:1. Last night, we didn't have enough staff to do that so the nurse ended up having to take an admit (stable acute MI post PTCA).
  10. by   New CCU RN
    We keep them 1:1... however, we do not staff for this, so when we have a patient requiring it, we have to call in extra help...sometimes we are in a pinch and we either have to triple or give the nurse with CVVH a very stable patient....
  11. by   fairone
    Absolutely 1:1. The patients that usually require filtering (CVVDHF) in our unit are the unstable, inotrope dependant, ventilated patients and filtering these patients can further potentiate their haemodynamic instablity. We also setup, manage and troubleshoot the filter. How it could even possibily be considered that a patient like this could be 1:2 is beyond me and I would out right refuse to take another patient.

    Additionally, despite the stability of patient, those who require filtering are always 1:1. Anyone using the Edwards Life- Sciences Aquarius? We've recently bought this for our unit after a long awaited upgrade. Just curious to know if other units are happy with this machine or any consistent problems with it? Thanks.
  12. by   shoelace
    Like fairone, I cannot fathom even putting a stable cvvh patient with another. Not all of our nurses are trained for cvvh; what if you're in your other room and the machine alarms? It clots off so easily sometimes.
    Not everyone would know what to do.
    Otherwise, there is not only bag exchanges once/hour, you have to mix the bags up, ensure adequate supply, give meds, draw labs, treat lab values, provide basic patient care, do calculations, etc. I think to ensure accuracy, these patients should always be 1:1.
  13. by   suetje
    We have a standard that all pts. on CRRT are 1:1, but for a more experienced nurse, you may be able to take another admit or pt. if they are lightweight (r/o MI, or stable vascular pt...). But these pts. are often on CRRT because they are the sickest pts...so why would you not single them? If you can do it, it is great.
  14. by   zambezi
    In our unit, pt is 1:1. Dialysis RN sets up prisma and get the patient started but after that its' all the primary RN.

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