ICU RN's responsible for CRRT or CVVH

[graciev]

What do you think about ICU RN's being responsible for setting up, troubleshooting and maintaining CRRT devices? Do you do this in your ICU and if so, what is your staffing ratio? If there are not a large volume of patients requiring this therapy how do you maintain competency among the many staff?ThanksGrace V

[guest239592]

In my unit (30 bed CVICU, largest in the state, and takes the highest risk pt's of the state) we use CVVH A LOT. We use the NxStage Machine (Which I hate by the way, had way less issues when we used Prisma in the past) ICU nurses control all aspects of the machine from initiating orders, to set-up, troubleshooting, changing filters, and discontinuing therapy (we do have a very good clinical engineer program at our facility and an engineer is always on call 24/7).

Our staffing ratio is always 1:1, for us it pretty much has to be, I can't remember the last CVVH pt we had that wasn't on multiple inotropes, pressors, antiarrhythmics, EF 10% etc. etc.

We use citrate and CaCal on pretty much all of our systems, but if our pt is real septic we're lucky to have it last 12-24hrs.

[esie]

In the Australian ICU I work at, we set up, maintain, troubleshoot and take down the circuits. The ICU I work at uses the Prisma, at the last ICU I worked at we used the Aquarius. It's interesting how two machines that have the same end goal can work so differently! All our patients are 1:1, regardless of ventilatory or other therapy status.

[Miniash]

In the SICU that I work at, which is 40 beds and pretty much 20 of them are all on CRRT, they have a dialysis tech on our unit 24-7. They are responsible for setting up the machine, trouble shooting any issues, and taking down the machine too. As nurses, all we do is record the values and treat the patient's physical issues (titrating meds when BP too low, etc). I have found it to be a very user friendly arrangement, and the techs are very knowledgable at educating the nurses about the machines.

[rnkumar]

In my place ICU nurse is responsible for setting up and trouble shooting CVVH,the HD nurse has no role in that.. CVVH is always 1:1