ICU RN's responsible for CRRT or CVVH

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    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
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    In our ICU, the diailysis nurse sets up the CRRT and the bedside nurse is responsible for running, maintaining , and trouble shooting the system. IF the system clots off, we may stop running CRRT & flush the line with saline and pack with heparin until the am when the dialysis nurse is in, or Call the dialysis nurse in to set up a new system. I myself would prefer it if they would let us set it up. I like to know all there is to know about a system I am responsible for. Our ratio is 1:1, but we had to fight for that. Now they are doing something called SLED, where its slow dialysis over a long time at the same ultrafiltration rate that doesn't require hourly adjustments according to I&O's like CRRT does. For example the doctor will order 10 liters off in 24 hours and the ultrafiltration rate doesn't change. they are going to make the nurse ratio 1:2 for thisI'm sure once it takes off. We have quite a few patients requring this on our unit so the problem of skill loss isn't so much.
    Last edit by dorimar on Oct 17, '05
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    Our nurses set it up and maintain it. We seem to go in spurts using it, but we have a new nephrologist who seems to utilize it frequently. We kind of just pass competency on from nurse to nurse. We have coordinators on each shift who are trained in it's use for resource. Patient ratio is always 1:1.
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    Quote from pricklypear
    Our nurses set it up and maintain it. We seem to go in spurts using it, but we have a new nephrologist who seems to utilize it frequently. We kind of just pass competency on from nurse to nurse. We have coordinators on each shift who are trained in it's use for resource. Patient ratio is always 1:1.

    Same here. We're inserviced on setting it up, running it,etc. Patients are one-to-one.
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    at our hospital dialysis nurse comes and sets up the crrt/cvvhd. the floor nurse is responsible for maintaining the machine, doing i&o and adjusting the machine volumes. there are tech's that can be paged but don't always come. there are no one to one patients in my facility, ever.
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    We now have a dialysis nurse in house 24/7. They set up the CVVHD and we are responsible for maintaining and simple troubleshooting. Our patients don't have hours during the night without treatment like they used to when set ups clotted.
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    we set it up and run it ourselves, staffing is 1:1 unless extreme dire situations, which is doing think i've ever seen. There is a class that we have to take (8 hours i think) that we have to take before taking care of that patient.
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    Hey Y'all

    Here in StPete, the dialysis nurse sets up the machine and I operate it overnight. I'd really like to be trained to set up the CVVHD that we use. When I was at the ShockTrauma in Baltimore, we could set up the Continuous Arterial-Venous Dialysis that we used.

    As I've said here before, the business of I & O and hourlly intake-ourput is the hard part of the CVVHD that we do. I wish I had more flexibility and control of my tubing, machinery and the dialysis process.

    Papaw John
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    Hello-

    In the MICU/SICU I work at (all RN's are cross trained for both sides, 30 beds total) once the nephrologist writes orders we are completely responsible for initiating therapy and running the machine as well as complete care of that patient. Our policy is that the patient is to be 1:1 due to the detailed I/O's and usually acuity of the patient. We also have a "shortage" of HD RN's in our area so sometimes although a patient at night in particular, might be able to tolerate hemo- the nephrologist will opt for CVVH because it's easier to just write the orders and not call an RN in at 2AM.

    We have an order packet that makes it very nice for the nurse and docs, the initial order sheet/flow sheet/labwork flow. Per our protocol we monitor labs Q 6 hours.

    The more you work with the machine, the easier it gets. The company that we use has made it very user friendly with colorcoding of pods and tubing. The only problem we have is there is never enough room...picture a vent, IABP, CVVH machine and then the numerous pumps of medication that the patient's on. I'm sure you all can relate

    Lisa
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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.


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