ICU RN's responsible for CRRT or CVVH

Specialties MICU

Published

What do you think about ICU RN's being responsible for setting up, troubleshooting and maintaining CRRT devices? Do you do this in your ICU and if so, what is your staffing ratio? If there are not a large volume of patients requiring this therapy how do you maintain competency among the many staff?ThanksGrace V

In our facility, we set up, maintain, and control the whole process. We have a 1:2 ratio always. We do CVVHD in spurts- sometimes there are many machines running, sometimes we don't have any patients who need them. I've actually had shifts where I had two pts. on CVVHD- let me tell you- I didn't even have time to go for a pee.:p

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we are doing that ,but u should pass first the competency for using this machine..

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Specializes in Critical Care Baby!!!!!.

we set up, maintain, troubleshoot, etc our cvvh machines, pt ratio is 1:1. i have worked in hospitals where dialysis came and set it up, and hospitals where we set it up.

my personal preference is to set it up. prisma set up is sooooooo user friendly, everything is color-coated and the machine takes you through the process step by step. i was nervous about setting it up myself, but once i did it i realized that my nervousness was unwarranted. it makes sense to me to have nurses set it up. the filters can clot off easily and oftentimes, if a pt is on cvvh they need it to run without any delay. waiting for someone else to come and set it up is a delay of treatment in my opinion. it is so easy to do, the patient should not have to wait until someone else can get there to restart the therapy.

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At my facility, we are also responsible for setting up the machine, troubleshooting, and making adjustments on flow rate with our CRRT patients. We do have educators with pagers who teach our classes we can call any time, but usually that is not a problem because there are at least one or two of our more experienced nurses working to help the newer nurses not as familiar with the machine. Our patients are usually 1:1, depending on their acuity level. (I have admitted with a CRRT patient, but we were going to stop treatment the next day and she was completely stable). If the CRRT patient is on a lot of drips or high acuity, then they are always 1:1. We have several classes yearly to keep up competency, but it is hard when we go a while and don't have them for the staff to remember. The more you run them though, the quicker it comes whenever you start running one the next time.

I noticed several mention if they had problems with filters clotting off, therapy would be stopped during the night. Do any of you use citrate and calcium therapy where you work? The citrate set up is fairly new at my hospital, but it has cut down dramatically on clotted filters. We have a lot of patients now who run 72 hours with no clotting, and then the filter has to be changed according to policy, but the filter is still running great after three days.

We use citrate where I work. Much less issue of clotting. Our patients are 1:1. Most of our IABP patients are 1:1 also but some of that is due to not alot of staff trained and willing to care for them.:rotfl: :nurse:
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We also set up, maintain and troubleshoot our crrt machines. Thank the lord for citrate because it saves alot of time and headaches trying to save a filter. We staff our patients 1:1 and given a one day class on crrt. We always have a pt. on it so competency is not a problem.

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At my facility, we are also responsible for setting up the machine, troubleshooting, and making adjustments on flow rate with our CRRT patients. We do have educators with pagers who teach our classes we can call any time, but usually that is not a problem because there are at least one or two of our more experienced nurses working to help the newer nurses not as familiar with the machine. Our patients are usually 1:1, depending on their acuity level. (I have admitted with a CRRT patient, but we were going to stop treatment the next day and she was completely stable). If the CRRT patient is on a lot of drips or high acuity, then they are always 1:1. We have several classes yearly to keep up competency, but it is hard when we go a while and don't have them for the staff to remember. The more you run them though, the quicker it comes whenever you start running one the next time.

I noticed several mention if they had problems with filters clotting off, therapy would be stopped during the night. Do any of you use citrate and calcium therapy where you work? The citrate set up is fairly new at my hospital, but it has cut down dramatically on clotted filters. We have a lot of patients now who run 72 hours with no clotting, and then the filter has to be changed according to policy, but the filter is still running great after three days.

In my institution, we have had complete responsibility for setting it up, monitoring etc. The system we have been using is terribly user-unfriendly. Also really big. We are now trialing several new machines, and only one does not require you to dump bags or hang them constantly (the Nxstage). And, ince the trend is going to the use of higher fluid volumes for these patients, the end result will be changing the bags every 1-2 hours., Seems like we could be doing more with our time than that! Of course, if you will tolerate using a dialysis machine, the same goes there, except last I checked, we were not Dialysis nurses. We also use citrate, and it is the best when it comes to keeping a circuit going for a long time. Anyone still not doing this therapy for their sick ICU patients is hurting the patients. Every time you have a HD Rn come in and do hemo on an ICU patient without a BP, you are killing not only nephrons that could recover, but making the gut ischemic, the liver ischemic etc. Why would someone do that when we are supposed to be healing people? You should use the machine that is easiest, and SAFEST...The Prisma machine and it's new counterpart have been stopped from being imported into the US by the FDA because the scales are inaccurate and can cause (and did cause) pt., deaths. You may want to be wary using it. This is public knowledge...I found it on the Gambro website.

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In my facility, we (ICU Nurses) set up and maintain the CVVHD ourselves. Like other posters, we also pass competency on from nurse to nurse, so there are a few of us who are very good at troubleshooting, and some who just don't take CVV patients at all. We staff 1:1, but the administration tried to fight this from time to time - they say "there is no standard that CVVHD or IABP need to be 1:1." Unsafe, I know.

Our Nephrologists refuse to use citrate and calcium. I don't have an opportunity to ask them why, either, as I work night shift, and they're never in. So, our run time is usually anywhere from 3 hours to 12 hours before we have to replace the venous side of the tubing. We do use heparin often, and flolan occasionally, but it's still not enough.

We were also told that we're the last hospital in the country using the Baxter BM-11A's and our administration, in their infinite wisdom, sold the 1/2 of the machine that governs UF / outflow, so we have to rig up a crazy system with strange tubing combinations and IV pumps. Our SICU has new machines they have been using for 8 months or so - we were supposed to get them for the MICU back in Jan, but you know how that goes......

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I am surprised that you state the scales are inaccurate because this is an operators issue not inaccurate scales. All machines do this if you ignore an alarm! I did go to their website and the FDA and it is training of staff. If you use a ballon pump, IV pump and ignore an alarm you can have issues. The ban isn't because of the machine scales and is suppose to be lifted. They didn't have to recall their machines they are still in use not like the Bxater machines

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Specializes in ICU, PICU, Orthopaedics, Spinal.

In my ICU (which is med/surg/neuro/trauma/anything else!!) in Australia CCRN's set up, troubleshoot and maintain CVVHDF, but if an existing dialysis patient comes in, the dialysis unit nurses will bring down their CRRT and do the therapy. Only CCRN's and those studying to become CCRN's look after patients on CVVHDF except in rare circumstances, and the ratio is ALWAYS 1:1 (but that's the case for all ICU patients anyhow!)

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Specializes in ICU, Telemetry.

In my facility the dialysis RN does set it up and is on call for problems. We run CVVHD and CVVHDF so I change the effluent bag, the dialysate and the replacement bags according to the machine and have had to discontinue trx and pack the ports when the filter has clotted off. I would like to learn the set up (it does not look hard). Patients are 1:1 if they are on pressors or staffing allows.

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we are trained to do the set ups. it takes about 15 minutes. the company helped setthe program up and the assists with review. Managing the patient is the hard part not the set up. I do not want to wait for dialysis to come in to set up. I know it can be a political issue but at least I can change filters when I am ready.

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