Does your unit do it's own CRRT?

[WWRN]

hey all,

the sicu i work in is considering learning to do our own crrt. currently, a micu nurse comes over and does it for us so we still have a two patient assignment... if we start doing our own crrt the crrt patients will be 1:1. for those of you that do your own crrt what are the pros and cons?

thanks for your feedback!:heartbeat

[nrsgnerd]

hey all,

the sicu i work in is considering learning to do our own crrt. currently, a micu nurse comes over and does it for us so we still have a two patient assignment... if we start doing our own crrt the crrt patients will be 1:1. for those of you that do your own crrt what are the pros and cons?

thanks for your feedback!:heartbeat

we do our own and use the gambro prismaflex. our pts are 1:1. the documentation and keeping all the bags going is labor intensive as well as if you have a pt that you have to adjust how much your pushing and pulling off based on their tolerance. you definitely will have a busy shift. we go thru phases with how many we have on crrt at any one time. our unit is a 17 bed unit, so if we have 2-3 on crrt at the same time, staffing gets harder. we still use dialysis nurses for regular hemodialysis, they just bring the machine with them but we have our own prismaflex machines that we share between cvicu/ccu/icu. i would say we have pts on crrt monthly but it may end up being that we only had one pt that whole month just in our unit...not including icu. the pro is that it is a 1:1 (and will hopefully always be), you have to make sure you document well to keep the acuity high and justify the 1:1 nursing care needed. you pretty much camp out in the room with the pt or very near by to ensure you catch it if they start to not tolerate. you have to make sure the catheter does not clot off. you also have to think ahead of what you need, make sure you have it and keep good contact with pharmacy to get the fluids you need when you need them-we have most of ours in a designated cart outside the room but have to order calcium gluconate...etc.... its organization, keen watch over the pt., good documentation, think ahead, protect the cath site and make sure you get all the other pt care and meds given. bottom line....you earn every penny you make that shift!!!!!!!!!!!!!

[hcox1975, BSN, RN]

I work in an SICU and we do our own also. But we usually have three patients to two nurses. So we each take one and split the other one. we have a dialysis nurse who does the set up and is in reach any time we have trouble. I personally try to avoid these patients because the machines are so easily thrown off. Even from something as not spiking the bag just right can cause air to get in, and then you have air in your blood and you can't run it back into the body and then you have a big ol' hot mess!

[meschell]

Where I work, we do our own CRRT. The HD nurse will set up the machine and do all cleaning and trouble shooting though. Our job is to just run the numbers, manage gtts, etc. CRRT are always 1:1, I've never seen anyone one who has one take another pt. You have to take a class to get trained, and usually orient with someone else for a couple shifts before taking one by yourself.

[Chisca, RN]

AAhh the days of being singled with CRRT. That is the IDEAL scenario, but these days staffing is so bad. If the patient is a 'stable' CRRT patient, we get 2 patients. LOL

And yes, we have to take a class and do yearly competencies for the certification.

It's cool to learn and do, but it can be VERY cumbersome. It's ONE busy assignment, so be prepared.

Yes, I've always found that term misleading, the "stable" CRRT patient. Only someone in management would use that phrase because if you really were hemodynamically stable you wouldn't need CRRT, you would get hemodialysis.

[evelyntanwy]

the MICU where I work in, RNs manage the CRRTs entirely by themselves after the Doctors orders the treatment. We do everything from the priming to the terminating of the treatment. It's an exciting and challenging task, but may seriously be cumbersome at times, since the patients requiring CRRT, may be ventilated and on IABP as well. Moreover, we do not get 1:1 nursing at all, and when the 'peak' period arrives, 1 RN may be nursing 2 patients on CRRT at the same time. ):

[evelyntanwy]

Originally Posted by bethenextstep

AAhh the days of being singled with CRRT. That is the IDEAL scenario, but these days staffing is so bad. If the patient is a 'stable' CRRT patient, we get 2 patients. LOL

And yes, we have to take a class and do yearly competencies for the certification.

It's cool to learn and do, but it can be VERY cumbersome. It's ONE busy assignment, so be prepared.

"Yes, I've always found that term misleading, the "stable" CRRT patient. Only someone in management would use that phrase because if you really were hemodynamically stable you wouldn't need CRRT, you would get hemodialysis. "

precisely! and to think that they were once running around the floors, nursing patients on CRRT as well. or perhaps the management have been too 'caught up' with their administrative duties that they've long forgotten the difference between haemodialysis and CRRT, especially in ICU where patients can collapse anytime during CRRT.

to put it simply, it seems that you start losing common sense little by little when you proceed to the managerial level.

this phenomenon seems to be on the rise, and it's pathetic.

[Chisca, RN]

Acuity is the 400 lb gorilla in the corner that no one seems to want to talk about. I have never seen an acuity system that scores for CRRT but the times I have cared for CRRT patients just for fun I scored them with the TISS and it was easily a 1:1. The hospital I work for disagrees but can't cite any evidence based research to support their theory.

http://www.sfar.org/scores2/tiss2.html

[APRN., DNP, RN, APRN, NP]

My ICU does it's own CRRT, and depending upon the situation, the patient can either rate a 1:1 or even a 2:1 if they are on 13 different drips and an unstable vent. It can be quite a lot to keep together when you're doing hourly In's such as tube feedings, blood, more than 10 IV's, and hourly Outs such as foley, JP/Hemovac, Pleurevac, rectal tube, NGT, etc.

We have a close relationship to our local dialysis service, and the dialysis nurse will come in and set up the unit and take it down. We do emergency returns if needed, while paging the dialysis nurse to come in to either change the filter/set, or do further troubleshooting.

[flo136]

We are 1:1 for CRRT, via a Vascath line. But if the patient has a AV fistula we get the dialysis nurses to come down and do it for us. Plus it also depends on the patient's condition.

[ICUSkeenRN]

I have done CRRT/CVVH but my unit does not do its own. We have an acute care dialysis service for our patients.

[kessadawn, BSN, RN]

I work pediatric ICU, but we do our own CRRT, set-up to end treatment. Only trained nurses PICU can do it, and in my ICU the CRRT patient is usually sick enough to require the 2 nurse to 1 patient status they recieve. It gets crowded in the smaller rooms, but it's a good experience, I really like those assignments!