CVVHD, still confuses me!

[mona4522]

I am new to a unit and have been told that I need to take a patient on CVVHD. I get some of the theory behind it but I'm still very confused. Can someone explain for me the role of the dialysate, replacement fluid and their path in the filtration system as it goes through the machine. So where does the fluid first go and where does it end up from each separate bag, e.g. ? to the patient or does it drain into another bag???

[BBFRN, BSN, PhD]

mona- if you go here: http://www.icufaqs.org/ and scroll down to the CVVH link, you'll find a really good explanation of how CVVH works, how it is set up, etc.

[mpccrn, BSN, RN]

the machine is usually set up by a dialysis nurse.....you only need to record the output (if that.....in some institutions the dialysis nurse does it all) your primary role would be to just make sure all is well, the connections stay patent etc.

[Dinith88]

the machine is usually set up by a dialysis nurse.....you only need to record the output (if that.....in some institutions the dialysis nurse does it all) your primary role would be to just make sure all is well, the connections stay patent etc.

Actually, most places require the icu nurse to do it rather than call in a dialysis nurse. This may work for your institution, but it's not cost effective and can be detrimental to the patient.

If you have to call in a dialysis nurse to set it up it can take hours...(when you can do it in 10 minutes once familiar with it)...and these machines are notorious for clogging/clotting off...(sometimes every couple of hours or so on certain patients)...which means having to call in a dialysis nurse...and waiting potentially hours between set-ups...when (like i said) a nurse familiar with the machine can get it up and running in 10 minutes. It's easy to see how this would be a very inefficient arrangement.

Now...if your institution staffs dialysis nurses 24/7 and the ability to pay them to sit with these machines 24/7 (and the ability to pay for 2:1 nursing care??) the arrangement may work...but...it's not the norm.

Most ICUs that do CRRT train their ICU nurses to do it. And it's a little more involved than simply recording output...