Cvvhd

Specialties MICU

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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?

I've read all the posts on this thread and would like to add a couple of observations. I've worked with this therapy for over 10 years and think it is a very important tool. First, CRRT is to the kidney what a balloon pump is to the heart. A bridge to mimic the function of an organ that is either too sick or too overwhelmed to do its job effectively. An organ that needs a rest. IHD and dialysis nurses deal with a large amount of fluid taken off over a small amount of time. Their patients are usually ARF and ESRD patients who have lost the function of the native kidneys. Many are not comfortable with CRRT. CRRT is used to try and preserve the native function in an otherwise compromised patient e.g. sepsis, ARDS, etc. As to staffing ratios for these patients: Most hospitals, including mine are 1:1. I have worked in hospitals where the patient is stable enough to take a second, low acuity patient. As to systems, there are several out there and I have either trialed are used them all. I've read a lot about emptying bags, drains etc. You must ask yourself that as a nurse what is most important to you? Lessening your workload or your patient outcome? Those systems that have bags and scales give me piece of mind that a drained system doesn"t. It allows me, through simple calculation, to see what is in the bag against what the machine is set up to take off. A drain does not. It's gone. You must trust that the system did exactly what it should have. What if there's a glitch in the software? How would I even know? Am I willing to put my patient at risk just so I don't have to empty a bag every couple of hours? I know that I don't trust IV pumps to calculate a constant on vasoactive gtts without checking that calculation manually. Check systems are a good thing and necessary for patient safety. Second, those systems that use bags are closed systems, read sterile. In an ICU with an already severely compromised patient why would I even think about risking a secondary path for opportunistic organisms?? An open drain in to a sink or toilet?? I don't think so.:nono: My goal as an ICU nurse is to give my patients every opportunity to make a full or as near full recovery as possible. CRRT conference San Diego: Go if you can! A great conference to learn, network and see what's out there. My hospital sends two RN's from every ICU each year. Training: Most manufacturers offer free training. Some are better than others. Ask for what you need to feel comfortable and competent with your hospitals equipment.:nurse:

In my ICU, CRRT and all other "dialysis things" are dialysis nurse job. During the whole procedure they are near the machine and take care for CRRT/dialyisis. We ( icu nurse ) take care for all others around the patients

I work in a large teaching hospital of a 30 bed ICU. Our patients are always 1:1 during CVVHD, CVVH etc.

Specializes in He who hesitates is probably right....

Always 1:1

We are also 2:1 for the first four hours and then the second nurse only takes a stable patient so they are available if needed. We do all setup and touble shooting and if we need to end tx fast then the second nurse comes back and someone else takes her/his pt.

We, keep them 1:1. You set it up, chg the dialysis bags, draw labs and send, tit drips and adm. lyte replacements, and basic pt care. Not to include constantly calling pharm so that your fluids will not run out!

Specializes in MICU, ER, SICU, Home Health, Corrections.

Wow... must be nice. I'm 3 months into the job and we're so understaffed I've already taken a couple of CRRT patients 1:1, and was scheduled for a second pt the next night; but had the good luck of a filter clot a couple hours before my shift started. Fortunately for me, it was a weekend, and the ologist decided to let the pt ride on his own for a night. [??] Experienced nurses tell me I should be able to do it 1:2 and they take CRRT and another patient routinely.

[i'd love to see our filter-clot numbers.]

It's mostly my shift; the other shift takes it more seriously. [We've got a 'shift of individuals problem' coupled with a 'shouldn't be a nurse' problem, with no cure in sight.] We do everything but the filter change, and scuttlebutt says as soon as the hospital/dialysis contract expires, we will purchase the machines and do the filters too.

We've also started hiring LPN's to fill the gaps.... assign one RN and one LPN to 3 patients... ? As for CRRT, the LPN's were in the class with me and will almost be able to do everything except d/c treatment, change the removal rate and restart the citrate/calcium should it be turned off.

rb

Specializes in ICU's,TELE,MED- SURG.
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?

When the mistakes are made due to a 2:1 ratio, how will the NM be able to defend herself in court? This is a very dangerous role and you will have to keep a log on paper every time this ratio is instituted. In your nurse meetings, make it clear that you will include this log in any patient mistakes that you or your co-workers face from then on. You must get a petition going to be sure that no Nurse is found liable for any mistakes due to unreasonable working conditions. I would also send this to the BON because it will affect your license if you are held accountable because you could not physically do your job safely and accurately.

Wow. I worked in the ICUs of a large teaching facility where the staff always has 2 patients (balloon pumps, Prisma, even an ECMO pt!) ICU RN responsible for setting up Prisma, troubleshooting, etc.) Consider yourselves lucky!!

and in my wonderful ICU, I had a cvvhd pt who had to be started on insulin drip, tube feeds, and blood transfusions (nevermind the lab draws, EKGs, and regular pt care). Yep, all on my shift. Did I say I had another patient, who was postop day 2 (thankfully stable), but on isolation for TB, and had to be tranferred out?! I don't know how I made it out of the unit after 12 hours!!!:rolleyes:

Specializes in Surgical/ Trauma critical care.

That's crazy especially if this is the norm!

Specializes in NICU.

I had a CRRT patient last week and I had 2 other patients. The patient was stable but on CRRT for an aspirin overdose. We ending up discontinuing his CRRT treatment around noon, thank God. I have never worked so hard in my life.

That day I started out with 2 patients (1 on CRRT, 1 septic GVHD with multi-system organ failure on xigris). Then at 0800 I got a rapid response from the floor that needed 2 units PRBCs, 2 units of Platelets, and a levo drip.

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