CVICU Machines and Staffing

[JeanOfAllTraits]

Hey friends,

In your CVICUs, are any of the other RNs outside of your CVICU core staff trained into any of the machines such as Balloon Pumps, LVADs, ect? If so, who are the RNs, as in what unit?

At our facility it is only the CVIUC RNs, no ICU float pool, no other ICU staffs. This winter the CVICU had a hard time staffing all of the machines between ECMO, open chests, RVADs, LVADs, Balloon Pumps and transplants. It's not uncommon for float pool to take a very stable LVAD that's not new this admission when they're in the ICU just for a few days of swan numbers and adding straight rate milrinone when staffing is tight like that.

Just wondering if you guys have others outside your CVICU who are trained. If you do, who? If you don't, how do you handle staffing crunches?

[Biffbradford]

Medical ICU will do CVVH and take the abdominal transplants, Cardiac ICU will do CVVH and IABP, Neuro ICU just does neuro, and CVICU are the only ones taking fresh hearts and thoracic surgeries, VADs of all sorts, TAH, IABP, CVVH. Floats to CV will get the easiest patients, but they still may be post ops going through DTs, or long termers with lots going on. More than once floats have left crying, or coding their patients!

[JeanOfAllTraits]

Do you ever have floats taking VADs or IABP?

[Biffbradford]

Never. I've seen stable LVADs paired with CVVH (). Never seen a float on a machine. To think of it, I was never given any machine when I floated either (and I did all machines). (not that all my float experiences were good!)

[JeanOfAllTraits]

Do you have a float pool that would be in the cardio icu more often or just floats from the other icus?

[Biffbradford]

No float pool ($$$ you know), just poor souls from other ICUs. "I have to float where??"

[MunoRN, RN]

I currently work in a large general ICU, so basically we're all float nurses. The same nurse might get a VAD patient, a CRRT patient, an ECMO patient, and a balloon pump patient during their stretch on. Each nurse accumulates competencies over time, so not all nurses take patients various support devices, but after a few years you most likely take everything.

[Here.I.Stand, BSN, RN]

I've been out of the CVICU for some years (my current SICU takes hearts but my hospital isn't the go-to place for hearts if the pt has insurance) Anyway, no they didn't have float RNs taking these pts. Although our ECMO pts had 2 RNs--one acted as the perfusionist and the other managed the rest of the pt. I remember having ECMO pts as the "regular" RN; I was not ECMO trained, so I imagine a float RN could have done my role. We had some float pool RNs who had been there and working in the ICUs for 20+ yrs, some who had previously worked in an ICU but liked the variety of being in float pool, etc. If available though, they had the float pool or MICU RNs taking the relatively stable pts.

[ghillbert, MSN, NP]

It is a Joint Commission requirement that nurses caring for VADs (at least with a Destination Therapy program) have documented training on the devices they care for. We do not ever have non VAD-trained RNs taking VAD patients.