Quote from RN34TX
I've read some of the CVVHD posts and apologize if I'm asking questions already answered but there were too many posts to sift through for the situation I'm in:
I've been an ICU nurse for just over a year so keep this in mind please.
I've taken care of maybe 3 CVVHD patients in my time. I work nights and there is always a dialysis nurse and nephrologist on call to troubleshoot if needed.
Each time I took a CVVHD patient I was coaxed into taking the assignment because there was always a nurse on the unit to troubleshoot it who was familiar with CVVHD, so I didn't worry too much because if the machine gave me trouble, I just called over to one of them and they were fine with that.
I got very basic instructions in how to return blood back to the patient in emergent situations, empty and change bags when needed and troubleshoot the "balance" alarms and that was about the extent of my CVVHD skill and knowledge.
Last night I took another CVVHD patient only to find out that I was the most knowledgeable person about CVVHD on the unit, no one else working that night even knew as little as I knew about managing a CVVHD patient.
I know that I could call dialysis if needed but wouldn't the line clot off or something worse by the time I got a response from them?
The patient was unstable on vasopressors and that seemed to be my biggest trouble, the CVVHD ran itself just fine as long as I kept up with the bags.
I fear that I'm in over my head and that there is a lot to know about CVVHD that I don't know and wonder if I have any business at all taking care of these patients.
I'd welcome a dialysis nurse's perspective even though they might be freaked out that someone with my limited knowledge has been taking CVVHD patients but also any other ICU nurses who take care of these patients.
How much do I need to know to take on the care of a CVVHD patient? If not enough already, should I be refusing the assignment?
are you using the Primsa CVVH machines? If so, then it really walks you through each problem. If you have a pt. on vasopressors, then try to minimize the fluid removal. You can always turn it off and still have the pt. dialyse.
also, if you run into a problem. Just return the blood. If you don't feel safe doing that. Just stop the machine then. Disconnet the pt. from it and hook the lines up to a flush. Notify the nephrologist as well.
Also, sometimes we turn the machines off due to short staffing, and they are usually grouped with another pt. Sometimes there are nights where you just can't manage the machine safely, so we decide to turn it off and re start the next day when staffing is better.
sorry to say, that is how it is these days with the shortage of critical care nurses.
Just keep the pt. safe and all is well.