What's "CVVH" in the ICU??

tutored · Oct 2, 2007

If any of the four kind RNs who responded to my plea for help and info yesterday - thanks again! Today went well, though I felt a lump in my throat when I first went in and saw the CVVH machine with a huge double-lumen line coming out of the subclavian, plus two picc lines, each triple lumen with SEVEN concurrent IV drips, foley draining the worst-colored urine I've ever seen, mechanical ventilation, septic beyond belief, and for flavor, a COMPLETELY OPEN abdominal cavity, with a incision from xiphoid to pelvis, covered only with what looked like a sheet of plastic wrap over it (waiting for preliminary closure in the OR), with four JP drains in various areas. You were all right - he was truly a sick man - I'm assigned to him tomorrow, but I'm afraid he won't survive the OR this afternoon. Thanks again, all of you!

withasmilelpn · Oct 2, 2007

I'm fascinated, let us know what happens, please.

cardiacRN2006, ADN, RN · Oct 2, 2007

Wow! Cool patient!

tutored · Oct 2, 2007

I will definitely let you know! Appreciate the care.

BBFRN, BSN, PhD · Oct 2, 2007

Poor guy- I hope he makes it through his surgery, Tutored. His poor family must be terrified. Does he have kids?

Hugs to you. I know it must be hard dealing with being fascinated, yet feeling terrible for this patient at the same time. Let us know how he does.

caroladybelle, BSN, RN · Oct 2, 2007

In ICU hemo/onco units, we have these, usually secondary to very severe Tumor Lysis Syndrome.

Needless ta say, they are sick as all get out.

richardjboro1 · Oct 2, 2007

So is this sort of the same type of care for a bypass machine? 2 on 1 with someone running the vent and someone doing patient care? Sounds extremely interesting/very sad though.

Richard

time4meRN · Oct 3, 2007

look under hemo dyal. or prisma

tutored · Oct 3, 2007

So is this sort of the same type of care for a bypass machine? 2 on 1 with someone running the vent and someone doing patient care? Sounds extremely interesting/very sad though.
Richard

Richard, that was, indeed, the setup...The primary RN constantly tweaked and adjusted the CVVH machine to the MD's desired net intake, or outtake...(In this case, the md wanted a deficit - lots of peripheral edema and anasarca due to the whopping sepsis in this patient's body - how about five antibiotics, plus fluconazole, plus steroids, and full sedation including paralysis? The amazing thing is this person's liver is actually holding up!) Thanks for asking.

tutored · Oct 3, 2007

Poor guy- I hope he makes it through his surgery, Tutored. His poor family must be terrified. Does he have kids?
Hugs to you. I know it must be hard dealing with being fascinated, yet feeling terrible for this patient at the same time. Let us know how he does.

Thanks for asking, and giving me the necessary reminder as a student that there's a person under all that tubing! He is in his mid-sixties, with visiting children and a bewildered wife. Tons of bible reading...he's full code, and there's nothing but optimism,...a kind of optimism that really isn't realistic in this case. As I said before, he was going into the OR this afternoon to have some partial-closure of his 13-inch abdominal incision...the only thing he's got going for him is his liver is somehow managing eighteen different meds (including steroids) without his enzymes elevating. I'll let you know! You're nice to ask.

palkie · Oct 3, 2007

most nurses in our hospital still call this cvvhd - continuous veno-venous hemodialysis, because that is what the older machines were called. depending on where you work and the speed at which they upgrade their technology, you may actually be using crrt. our hospital uses machines made by prisma, and it stands for continious renal replacement therapy.

it is the same thing - an "artificial" kidney that takes over for patients in renal failure. it causes less major swings in patient acuity due to the 'continuous' factor than intermittent hemodialysis and is very good for icu patients.

yes, it is possible, even likely that your patient may be sick, even very sick - but it is possible they may be relatively stable. i have used these machines (even the old honking dinosaurs) for over 14 years. patients on these newer machines do much better than in the past.

we have also had patients on them who really were really very stable, although at our facility we try our best to make these 1:1 nurse/patient ratio assignments whenever possible.

it takes a while to get the hang of writing down all the numbers every hour, and can get busy if your line (access) is not patent, but certainly you will have help - a preceptor or someone who can show you the ropes, right?

ask all the questions you can. there are no stupid questions! and anyone who says otherwise is an idiot, so stay away from them!! (haha!) much more stupid not to ask! and yes, unfortunately some nurses do eat the young, so beware - but keep asking, and you will find someone who will help you and guide you. we're not all bad! good luck!

Christie RN2006 · Oct 3, 2007

Sounds like a patient that we had recently in the ICU where I work. This one particular patient just about coded several times... I never did hear what happened.

What you mentioned about remembering that there is a patient under all the tubing is very true. As a new nurse, sometimes it is very hard to see past the tubing to the patient. You are so focused on the patients physical needs and getting everything right that you tend to look past the patient emotional needs and their family. It is something that comes with time. I have only been a nurse for a little over a year now and I am starting to get better at it :) One thing I learned early on is that the family is sometimes just as needy as the patient is. You need to not only provide support for your patient, but their family too. The family will then in turn support the patient. Unfortunately it doesn't always happen that way though.