Venting some frustration here. Less than 6 months ago I started working at a new facility. They use the same Prisma machines that my last place had, however there are several things that are routinely done at the new place that seem sloppy to me. Maybe others will agree?
1. My biggest issue is with the replacement sol'n. They only hang 1 liter of fluid at a time. With replacement fluid rates often running at 1L/hr, or 1.5 L/hr, in my opinion, this is completely inefficient. Changing bags every hour, or every 1/2 hr-45 min is crazy, especially when about 50% of the time my hospital pairs these patients. I am used to the method of hanging 3 seperate one liter bags on the multi-pronged replacement hook-->connected to a set of stopcocks with IVPB tubing--->connected to the main replacement line and secured evenly to the side of the machine. Of course when I suggested (and implemented this), it was brought to my attention and I was scolded. When I mentioned to management that this method does work safely, can save alot of time for the bedside nurses, and could save the unit money by making the more "stable" CRRT patient more-easily "paired with another patient", I was ignored. When I then suggested they look into purchasing larger volume replacement sol'n bags, I was again politely ignored. Funny thing is how my hospital preaches about having the nurses suggest "process improvement" ideas - well apparently they dont, unless maybe its something trivial and cute. UGH..whatever.
2. Often times I find effluent bags in unsanitary conditions, draining into dirty toilets. Once I discovered a bag draped on the side of the toilet with the tip under water, and unflushed stool inside. They dont stock new effluent bags, except in new filter sets at this place.
3. Have started my shift several times with Calcium carelessly infusing into the filter, and citrate infusing into the patient, instead of vice-versa. Wrote that incident up when my filter clotted.
4. Found heparin 25000 unit bags infusing instead of citrate, 160 ml/hr. Who knows for how long. Pt's PTT off the chart. Corrected the problem. Wrote that up as well.
Bottom line: I'm starting to be viewed as the CRRT bad guy, whistle blower, and "know-it-all", but ....these ppl have no idea what they are doing! I'm not one of these ppl who comes to a place and tries to change around the status quo for my own gratification; I just want to make a few things more efficient and safe.
All this, combined with various other sloppy non CRRT issues/practices is making me want to take my nursing license intact and run back to my old job.
O!M!G! You are doing a GREAT job of quality assurance and your institution does not appreciate it? Geez! I would suggest to your Manager 1st you initiate a QA program for CRRT. Note the errors you have witnessed, and keep writing those incident reports. I did at my institution and found many errors. We also had a couple of incidents with the citrate that led to a hospital-wide review of what to do and not to do with it, and how to make sure it is in the right place!!!! Can't believe you are still using the Prisma machines (not the Prismaflex?) They were shut down by the FDA because the scales were inaccurate, and people bypassed the balance alarms leading to hypotensive pts with too much fluid off! That AND the P-Flex I think are less than user friendly, and I wonder about the scales. They claim to have fixed the scales since that. We had a number of adverse events with it!
You might want to look at other, (what I, in bias) would consider safer options for CRRT. What if you didn't have to empty drain bags? What if you could hang your whole shift of fluids one time? It is a reality and they are #1 in the US. http://www.nxstage.com. Trust me. Thousands of happy costomers laterI know it is true...and safer than Prisma!
IheartICUnursing
86 Posts
On our unit, we have a drain in the wall of every room to plug in the effluent line to. I guess that is a luxury, from what I'm reading here!