CVVH and the 1:1 assignment

1:1, obviously because if this patient is hemodynamically stable enough then most likely you would be using regular hd instead of cvvh/crrt in most cases...performing cvvh and maintaining accurate i/o while titrating drips is enough to keep u busy for a few hours...IF an IABP pt can in MOST cases be considered 1:1, then def CRRT is a candidate...

Hey SnowyMtn

(Love your handle!!!) I agree with hrtprncss--as so often--that CVVHD is a 'chart sign' of a Pt really really unstable. And the work of 'accounting'--the complex I & O of this treatment take me alot of time. And the risk to the Pt of a line coming loose and exsanquinating while you're not in the the room...well---

But ya know, the people who pretend to "administer" hospitals look at their budget and see you sitting in your pts room with your calculator and think what a large share of their budget is spent on Nurses' salaries so they think they'll cut their losses by getting more work out of you.

They don't realize that (thinking like a business) Nurses are a PROFIT CENTER.

Look--what do you pay to spend a night in a Holiday Inn? Maybe $60 to $100? What do you pay to spend a night in an ICU? Maybe $1000 or $1500.

What's the difference? At the HolidayInn, if you wanted too, you could rent/lease a vent, a cardiac monitor, arrange pharmacy and medical supplies to be delivered to the motel and labs to be picked up. You couldn't charge the traveling public any more!

The difference is that the Hospital has NURSES. The diffence between $60 and $1000 is YOUR SMILING FACE.

Don't back down. The administration that wants you to have two Pt's with one on CVVHD is full of ****!!!

Grumble Grumble

Papaw John

On our CCU are CRRT patients are 1:1, and on the med/surg ICU they are 2 nurses to one patient....these patients are just so busy, we barely have time to critically think

2 nurses to 1 patient!!! where in shangrila lol that'd be the day in most places

In Minneapolis....

Absolutely 1 :1!!!

Our new nurse mangager tried to pull that crap with us, it didn't fly! What are they thinking??? Obviously not about the care of the patient or your license.

Always 1:1 here.

1:1 99.9% of the time in my unit. On extrememly rare occassion (well, only once actually) I have seen CRRT paired with a stable patient.

We just started using Citrate...if the patient is on citrate, we 2:1 for the first four since it is so new to us....or we will 2:1 with 2 patients- the CRRT and one stabler patient...

If the patient is IAPB and CRRT- we make them a 2:1 (also rare at our institution)

always 1:1 for us as well. calculating the I/O's, readjusting the machine, (and trying to keep it running), changing the dialysate and replacement fluid bags, checking coags q2 and adjusting the citrate as needed, and doing everything else that is involved, how could it not be?

At my hospital, the house manager has his/her own set of priorities. Many times when a patient is on CVVH/CRRT the hosue manager will try to browbeat the charge nurse into forcing another patient on the CRRT nurse. They will typically start out by saying that the patient isnt that sick, or there stepdown status or some other "pitch" to get the patient into the unit. Then when the patient crumps, that charge nurse of other nurses must care for the crumper while the CRRT nurse continues on. What really makes me angry as hell is when a house manager who has never worked CRRT before assumes because your just chasing labs, bags of fluid and I&O's that your really not "that" busy. Finally, if the suits don't like to pay for one to one care then STOP admitting the patients to your hospital and send them to a facility that places ethics BEFORE economics. Peace

hold on to your hats everyone...............the hospital that i worked at for 6 years always paired their cvvh patients, usually with someone waiting to go to tele. this was in a very high acquity open heart unit in the chicagoland area. it became the norm very fast. they also pair their vad patients 2 days post op! :uhoh21:

it is very scary! the last day i worked there my assignment was this..........an open heart patient first day post-op still vented on an iabp with dopa, epi, levo, and primacor, my next patient was 3 days post-op, extubated, still had iabp and dopa, and my third patient was someone waiting to go to tele who developed hypotension on me! scary scary scary!!!!!!!! i left there with my nursing liscence in tact.

it was sad leaving though, because the nurses i worked with were wonderful and we all got along great! the surgeons were awesome too. we were one big family. the management and administration sucked, i guess good manangement can make or break you. they have an extremely high turn over rate. wonder why?