Cvvhd

Specialties MICU

Published

Our manager is trying to convince us that a patient on CVVHD is not a 1:1 patient. This therapy requiers constant monitoring and calculation changes. Usually they are not very stable, or they could have regular dialysis. Are any of you doing this in your ICU's? Are they 1:1?

Specializes in Cardiothoracic nursing.

:chair:

In my unit (CT surgery), we use PRISMA (CVVHDF) a lot of times. Usually those patients have inotropic support, are haemodynamic unstable, ventilated... We make the initial setup, the priming and all additional settings. The ratio it´s 1:1.

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Specializes in Med-Surg Nursing.

Pt's on CVVHD in our unit are SUPPOSED to be 1:1 but due to our tight (read short) staffing sometimes they are 1:2! I think this is ridiculous but then again in my unit we frequently have 3 pt assignments. If someone calls in sick, we're in trouble. I work straight night shift and 3 pt assignments are the norm rather than the exception.

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We Are Mostly Doubled With Patients Like This (meaning 2patients To One Rn, Occasionally We Will Receive Ancillary Support, I.e. Technician) It Is Not Uncommon That We Have A Fresh Post-op And A Patient On Vasoactives And Cvvhd Or Any Other Form Off Crrt.

:)

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:rotfl:

Pt's on CVVHD in our unit are SUPPOSED to be 1:1 but due to our tight (read short) staffing sometimes they are 1:2! I think this is ridiculous but then again in my unit we frequently have 3 pt assignments. If someone calls in sick, we're in trouble. I work straight night shift and 3 pt assignments are the norm rather than the exception.

Nurse Lou, ...all the more reason to have a machine with LESS worklload!!! If you have a bad access, it is a bad day no matter what equipment you have. But if you don't have to hang and drain bags, you can work with the PATIENT, NOT the machine!!!

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I wouldn't say that its the cvvhd that makes these guys 1:1's. In our unit it's all the other hoopla of instability, maxed on drips... you bring the crash cart into the room to do a code brown, look at them for a second too long and their pressure is in the toilet that makes them cvvhd, not HD.

Reminds me of when IABP's were 1:1 mandated, until we saw sicker and sicker patients, and it was suddenly "doable" to pair a pump with the most stable r/o MI, then the next day it seemed you had a vent with a pump... then the manager says... well this pump is stable and you're weaning him... let's pair him with the other pump...

I think a huge part of this is that slippery slope where once we become more skilled in our time management with sicker and sicker patients.. we're asked to take on more and more... Until what was considered obscenely unsafe a year ago is now common practice. You look back and think how the heck did this happen?

It makes you wonder why nursing school requirements now don't mandate that you have 4 extra arms surgically implanted to be able to handle the workload. Meanwhile administration has the aerosol valium spray that dispenses Q5 minutes to keep the staff "happy".

Sorry, diving off topic here rapidly. I REALLY sense your concern... :angryfire Where will this STOP? How much more can we do and provide the care that we need to give. There are SO many patients that need to be 1:1's and are not.

I'M WITH YOU! Sick enough for cvvhd, you're a 1:1 until the Hd nurse shows up for regular dialysis.

Again sorry for the rant and rave :uhoh21:

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1:1 here and also IABP still 1:1 please don't mention all you are doing to the managment here! LOL I am sure it is only a matter of time until they try just what you mention, Heart Queen

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our cvvhd pts. are 1:1 if unstable and if stable 1:2. Team work is the key here and my coworkers are great so we never have a problem feeling overwhelmed. Godd luck.

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Unless the patient is on vasopressors as well, we staff 1:2. However, the acuity of the other patient is taken into consideration when staffing.

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On my unit, CVVHD is strictly 1:1 care. And I would like to add that I feel it is very unsafe for nurses who have not been oriented to the machine to be taking those patients. I have worked three years on my unit and so I am considered a seasoned night nurse, but my preceptor never liked to take CVVHD so I never got a lot of experience with it. I can take care of a patient on it if It doesn't give me problems, but I can't set it up by myself if it clots off and I can't trouble shoot it very well. I hate it! I have never had a REAL inservice on it and I think Its a shame that patients and their families trust us to run it when we have no control over our competency with the machine. Many nurses on my unit feel the same way.

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In our hospital it is always 1:1. In my two + years in critical care, I have never seen it otherwise. Granted, most of the patients on CVVHD or CVVHDF are on vasopressors with Swan Ganzs and are always intubated.

Linda

P.S. Does anyone know of a really great inservice program out there? I'd be willing to travel in exchange for some serious education.

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In our hospital it is always 1:1. In my two + years in critical care, I have never seen it otherwise. Granted, most of the patients on CVVHD or CVVHDF are on vasopressors with Swan Ganzs and are always intubated.

Linda

P.S. Does anyone know of a really great inservice program out there? I'd be willing to travel in exchange for some serious education.

Linda;

If you can afford the time, you ought to go to the CRRT symposium in March (10 - 12) in San Diego. It is 3 days of all aspects of CRRT, from access, to machines, to research about what is best, nursing issues etc. I wrote a program for Baxter for core CRRT education, and I know the Prisma people had one too. Nxstage also has one. But if you can go to the CRRT meeting, you would REALLY love it! Not only is it beautiful there, but the contect is CRRT and ICU issues. Go to http://www.crrtonline.com and check it out or search on CRRT.

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On my unit, CVVHD is strictly 1:1 care. And I would like to add that I feel it is very unsafe for nurses who have not been oriented to the machine to be taking those patients. I have worked three years on my unit and so I am considered a seasoned night nurse, but my preceptor never liked to take CVVHD so I never got a lot of experience with it. I can take care of a patient on it if It doesn't give me problems, but I can't set it up by myself if it clots off and I can't trouble shoot it very well. I hate it! I have never had a REAL inservice on it and I think Its a shame that patients and their families trust us to run it when we have no control over our competency with the machine. Many nurses on my unit feel the same way.

Don't you have a regular 'theory' and content course every 6 months or each year on CRRT? What type of machine do you have? Most companies have a program that at least they might forward you the material so you could understand it. Also, I just replied to Linda's post, and you ought to consider going to the CRRT meeting in March in San Diego. It is Really helpful for anyone who is not understanding this therapy. There are a number of older articles on it too, from the early days when it began being used. I can point you in the directin of some if you are interested. E-mail me :[email protected]. It also depends on what machine you are using. Some are incredibly complex (I know I work with one!)

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