1:1 for CVVH?

Specialties MICU

Published

I thought CVVH was 1:1. I interviewed at a MICU and they staff it as 2:1 uncless unstable. Any thoughts?

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Specializes in CCU/CVU/ICU.
...unless unstable. Any thoughts?

The whole point of CRRT is that the patient is too 'unstable' for conventional dialysis... If the unit routinely classifies patients on CRRT as 'stable', i'd be suspicious...

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Specializes in ICU/CCU, Rehab, insurance, case manager.

I believe the Norm is a 1:1 ratio for thoses patients. I would be cautions about joining there so that you are not place in a hard situation.

HTH

Jamie

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Specializes in Family.

Our unit is 1:1. How in the world could you get anything done with a second pt?

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I just left a MICU job where CRRT pts were routinely 2:1. Even if they were on Levo and paralyzed they would be paired...and sometimes with another not so stable pt or another one with every 1 hr blood sugars. I worked there almost 7 long and hard years. I am so glad not to be worked like a dog anymore. It wasn't a safe place to be, but I guess it kept their budget on track. They were a for-profit hospital and most concerned with the bottom line.

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1:1 for us

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Specializes in Nephrology, Cardiology, ER, ICU.

Like another poster stated, CVVH is for UNSTABLE patients that can't handle regular dialysis. Ridiculous that it would be anything BUT 1:1.

Here is a PowerPoint presentation from a university teaching hospital that clearly states CVVH is 1:1 nursing care:

grove.ufl.edu/~weineid/RenalLectures/GME/ARF in the ICU.pdf -

Another article from the Resp and Crit Care Medicine journal:

http://ajrccm.atsjournals.org/cgi/content/full/162/3/777

And finally, common sense needs to prevail. I'd head on down the road to the next ICU.

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Ohhh...don't get me wrong....I agree totally. It just wasn't the case where I worked. Just like paralyzed patients should always be 1:1. That wasn'r always the case either.

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Specializes in ICU, currently in Anesthesia School.

Let me preface by saying that I believe far too many patients that are in ICU's are paired, and that CRRT should be a 1:1. Otherwise, the patients are not getting the quality of care they need or deserve.

That said, forgive me for the following rant and feel free to skip to the next posting- I am also becoming convinced that we are using CRRT too late in the game due to the propensity of renal docs to bend toward traditional dialysis for whatever reason, (comfort with technology, reimbursement, etc.) I had to do some research on the subject lately, and in Italy and Australia the propensity is toward putting patients on the machines earlier. The patient outcomes are better and renal recovery more likely in the studies I've seen. Granted, there are flaws and the populations are small, but it does deserve a closer look. Think about it- You have a patient in the early phase of sepsis, the kidney's are showing insufficiency and we watch them. We give nephrotoxic antibiotics and we watch them. We put them on pressors because they are not perfusing and we watch them. Now we are in renal failure and maybe we should think about dialysis, but they are hemodynamically unstable so let's put them on CRRT. Maybe, when the kidney's were telling us they needed help, we could have at least mitigated some of the damage done by the disease process. Proactive instead of reactive therapy.- Just a thought:)

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