Acute HD by ICU staff

[prwd2bRN]

I work in a hospital based hemodialysis unit. My administration and management are planning on training ICU nurses to do acute hemo treatments. My coworkers and I are concerned :angryfire because after 3 years of doing SLED, the same ICU nurses are still unable to trouble shoot effectively. We anticipate catastrophy!

Here are my questions:

1.Are there other hospitals in the nation that has this practice in place?

2.What hospitals are they?

3.Has it been successful for them?

4.Is there evidence based info. for my administrators that will show them this could be a bad idea?

Thank you for any help :bowingpur

[Chisca, RN]

I suppose it is theoretically possible but I don't see it as practical. SLED and hemodialysis are two different animals even if the machine is the same. Sort of like non-invasive ventilation verses being intubated. Unless you are performing hemodialysis frequently you are not going to maintain your skills. All I have is ancedotal but I was an ICU nurse for 22 years, CCRN certified, before transferring to acute dialysis unit and it took me 6 months before I could consider myself independent. After a year I still don't know enough to sit for certification. Do you know the difference between grafts and fistulas and how to troubleshoot them? What happens if there is too much chlorine in your RO? If your management really is commited to putting in the time to educate you it could work but I don't see how you will maintain your proficiency unless you do it all the time. If management is wrong about this you will be looking at a sentinel event for some poor patient.

[prwd2bRN]

Thank you for your input. It's good to get feedback from the perspective of a "been there,done that " CCRN. I think this will be helpful in our stand.

[zimm4er]

I totally agree with the above post. Hemodialysis is much more than it looks. To truely be good takes lots of "practice." AN ICU patient is not where they should ne practicing. The one thing you brought up is the ICU staff at my hospital would not be willing, and would scream out of their scope of practice. After 5 years of sled most nurses are able to troubleshoot mostly on their own. As you know there are those on bost ends of the spectrum--those that are great and I call sled savvy and those that can't even return the blood or do hardly any troubleshooting and think you are their dog. Your administrators are also not thinking about the $$$$--why give away part of your job that brings in lot's of revenue. Two big issues that usually get admin --pt safety and revenue. will stick with sleds and hemodialysis. thank you very muvh

[lil'smile]

We do CRRT in our units but only basic troubleshooting, the ADU staff set up and manage most aspects of the machine and the ICU nurse manages rate, takes the pt off and takes care of basic alarms. If we have trouble the ADU staff is supposed to be available for help. When you only do it rarely there is definately not a good comfort level and more training would definately not be amiss. With critical patients there is also not a lot of leeway.

[rninmi]

I was an ICU nurse and we had to dialyze our own pt's. It became an absolute disaster....Imagine a 2 wk s/p gsw with 8-10kg on, intubated, art line, swan...the works AND you have to dialyze them...not to mention your other pt next door! It was a joke! The charge nurse would usually jump in and do your run for you, but that bogged them down.....it got to be unsafe. Plus like others have mentioned, you cannot be "independent" in HD without doing it for at least 6mos consecutively....Looking back I thought I knew what I was doing, but now I know I had allot to learn about HD.

Eventually the hospital hired a company to do our tx's (after I left!). We did purchase 2 of the gambro crrt machines, and I believe the room nurses still set that up and monitor it...but that is allot different with allot less complications.

[kat29]

We have a similar set up at our hospital. The acute dialysis unit (4-5 beds) is actually a part of the ICU. We have a number of nurses who work both dialysis and staff the ICU. If an ICU patient has to have dialysis, the unit nurse scheduled for dialysis that day will come to that persons room and dialyze. The patient would essentially have 2 RNs (their ICU nurse and their dialysis nurse-who is also one of our ICU nurses). If there are floor patients who have treatments scheduled and also ICU patients, we get another of our cross trained RNs to help out. These nurses have been working both dialysis and ICU for years though and are very experienced. We also have some PRNs that are strictly dialysis but again, it is considered part of the unit. It works out well, expecially if the patient suddently becomes unstable. We (the rest of the ICU staff- and the code team) are right outside the door if help is needed.

Feel free to PM me if you'd like any more info.

Let me clarify too that the RN scheduled for dialysis on a particular day is just that...DIALYSIS. He/she is NOT at anytime the primary nurse for that patient. You should never be staffing the unit and dialyzing at the same time!

[prwd2bRN]

This helps a lot - thank you!