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?

We use Prisma. Our cvvh's are always 1:1.

Our ratios in the ICU are 1:1 or 1:2 max. If we're talking fractions of nurses though, a 1:1 assignment is always 1 1/4:1 and the 1:2 assignment is always

1 1/8:2. Always. This is the way our unit is staffed...we use float nurses (staff nurses) who do not have an assignment per se, but float to help out other nurses on the unit and to cover breaks. This does not count the charge nurse who does not have a patient assignment.

So actually our cvvh's ratio is 1 1/4:1, always.

We use the Prisma also which is very easy to set up.

Our CVVHD patient's are 1:1 for the duration.

Denise RN, BSN, CCRN

Specializes in Critical Care/ICU.
You are lucky!

Believe me, after finding this board and reading what it's like for a majority (it seems) of RN's, I KNOW I'm lucky. Or is it that this hospital has great management, an open supportive dialouge with staff, and really is patient and employee oriented? A good union doesn't hurt either.

It should be like this everywhere!

I really really really wish ALL nurses could feel the satisfaction I feel in my job and my employer. Sometimes I feel bad posting such positive comments when everyone else seems to be suffering. :uhoh21:

Anyone out there has the manual or know-how on the Aquarius machine? I am used to Prisma and the ICU I am working in has acquired 2 new Aquarius machine which the NM is pushing all of us to use. I would appreciate of anyone can tell me the advantages of it over Prisma, and also how user friendly it it. Thanks!!

Can anyone out there tell me more about the Aquarius? I am used to Prisma,but very new to the Aquarius. I would like to know the advantages of Aquarius over Prisma, what are the added features of Aquarius and how user friendly the Aquarius is. Thank you...

1:1 Is The Only Safe Way. Are You Kidding Me. If Your Manager Does Not Want A Really Bad Patient Outcome, She'll Uphold The Policy Of Cvvh Patients Being 1:1.

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?

Very very rarely, maybe once or twice do to call ins and staffing issues have our CVVHDs not been 1:1. There is no way it is safe to take on another patient. With all the labwork you have to do, much less controlling your flow rates to keep a pressure, if the machine alarms, and you're in another room, it is asking for trouble. There is so much to stay on top of with these type patients, you don't need the distraction of another patient on top of it. If something goes wrong or gets missed, the docs are going to care that you had another patient, there will be no excuse in their minds. I would let the manager know when he/she can take a CVVHD patient with another patient and competently, safely give care to both at once, then consider changing your policy to make a continuous dialysis patient safe enough to take another assignment. Patient safely should be paramount over staffing, budget, etc. What is your manager's rationale for doing it? It can't be in the best interest of the patient.

Specializes in NICU, PICU, PCVICU and peds oncology.

I'd just really be happy to have a manager who only makes assignments that she would be willing to carry herself. CVVHD definitely must be 1:1.

Specializes in MICU.

Our CVVH's are 1:1 ALWAYS. If there isn't enough staff, that means someone else has a 3 patient assignment of hopefully stable patients. We don't even leave the room to go to the bathroom in our unit or talk on the desk unless someone else comes into the room or sits outside the room. For some reason, we are extremely fearful of catheter disconnection and exsanguination in my unit. That seems to be the driving force behind the 1:1 ratio more than hemodynamic instability.

We're 1:1 here too.

Can anyone out there tell me more about the Aquarius? I am used to Prisma,but very new to the Aquarius. I would like to know the advantages of Aquarius over Prisma, what are the added features of Aquarius and how user friendly the Aquarius is. Thank you...

Aquarius is much (much) cheaper than a Prisma to buy and their artificial kidneys seem to last longer. It's a good unit IMHO, but a little over-sensitive and occassionally has niggly issues, failing it's self test when turning on repeatedly, then passing once a biomed comes to check it out. Tries a little too hard to be user friendly, the software could use some improving.

The Prisma is a good, reliable work horse. Much easier to load a set (on the Aquarius, all the loading and unloading of the tubing and kidney is all done manually). The arrangement for the Prisma set is very neat and tidy and it's easy to see what's what, where the Aquarius looks like a spaghetti arrangement when it is in full swing.

Biggest problem with both of them? Lifting heavy bags full of fluid onto the anchor points beneath the units. There must be an easier way....

Functionally, they pretty much do the same things. Not much between them. Given a choice between them I think I'd choose a Prisma, but the cost of the Edwards unit, and the life of the kidneys, is very appealing.

Our CRRT pt.s are always 1:1. We are a very team oriented on our unit and help out with priming and starting the machine for the nurse who is taking the patient and is not very experienced with the machine.

yeah we do that..... and it is absurd to think that this would not be a 1:1 pt ratio..... have someone go down the tubes on you when you are running the circuit or better yet when they have ICU psychosis and the institution that you work in has gone restraint free.... and they pull it apart and bleed themselves.....

Two Words

SAFE HARBOR

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