CVVH and the 1:1 assignment

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I have a question. In your hospitals, if a patient is on CVVH, are they automatically a 1:1 assignment? Or is the nurse expected to carry more than one patient regardless of the hemodynamic status?

Any nurses who work with CVVH please respond as this is an issue at my hospital, so i'm conducting a sort of survey just for my benefit.

Thanks

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Specializes in ICUs, Tele, etc..

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...

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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

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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

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Specializes in ICUs, Tele, etc..

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

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In Minneapolis....

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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.

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1:1 only, unless they wish to give you an extra nurse. But in no way should you have a second patient.

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Always 1:1 here.

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Specializes in CCU (Coronary Care); Clinical Research.

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)

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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?

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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

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