koyeh

The rep. just says per your hospital policy. I think they fear lawsuits etc if they recomend anything. Thanks

Thats my problem, I'm soppose to develop a policy & "train" everyone. It's simplistic to use, turn it own, set temp. apply to tubing. The doctors will not answere any of my questions regarding temp. etc... They have said, its a doctors order and to call and they will give an order at that time. So that is how I am writing it into the policy. I was hoping to hear what others were doing. I did hear that one hosp. sets theirs at 36 C and their patients don't develop hypothermia but they don't have any policy regarding it. (This is the information I hoped to hear so I could instruct others with some confidence.) Nursing applied a blanket warmer when they felt they were too cold prior to this. We have 2 and have to borrow from another unit. The doctors say, we don't like them but never ordered them removed. Thanks

I've worked 23 years in nursing and have done trauma, SICU and now MSICU. What I've learned is that there are challenges at all of them. What makes the biggest difference is who you work with. If your a tight crew and help each other out the job is more manageble and a lot less stressful. If the Doc's have the "God Complex" you can have a bad day until they learn to respect your nursing. So pick an ICU that holds your interest, the grass is always greener on the other side.

CRRT & Hypothermia: What temp. do you consider cold and start trying to warm the patient with either a heating blanket or some other warming device? The reason why is our renal doctors want to run the patient cold so they vasoconstrict and require less pressors. They keep saying they run the inpatient dialysis patients (3 to 4 hr treatment) at 95 F. My concern is CRRT is 24 hours a day and to be cold all day has to be discomforting. The doctors did say if the patient starts to shiver than they will permit us to apply a warming blanket to reduce oxygen demands. The only articles I found say, hypothermia is a side effect of CRRT but no specifics. Thanks

Our hospital propofol is 24 hours. started out every 6 hours then went to 12 hours and now 24 hours. This all came from a study someone did. Our infections rates are unchanged with the 24 hour change.

Tubing 72 hours, TPN,propofol, ativan, and antibiotic tubing 24 hours

We are getting new prismaflex machines with an external heater. The heater can ge set up to 40 C. Does anyone have a policy regarding the heater regarding what to set the temperature at? Thanks

Our hospital went with Gambro and prismaflex, looks like a good move. They provide education and answere questions quickly.

We do quite a bit of CRRT and they are starting to do it earlier and the sucess rate has improved. Yes people make it.

Hi, I know its been months since your question but I felt like a response is in order. It seem most hospitals have very poor education regarding CRRT. At our hosp. Get 4 hours training with the machine (set up, trouble shoot etc.) Thinking about adding theory, calcualtions, crtitical thinking etc... This is being done by nurses who know the most and trying to pass on there knowledge with support of the unit supervisor.

Hi, yes I work at Mission. I am a diploma nurse, worked a couple of years and went back to college to get my BSN. Thought about a masters etc... really don't see the advantage yet. I like the idea of working in the ICU and coming home and forgetting about the place, While I was in College I worked part time in oncology at a small hospital and I glad there are people like you to work in that area.

You are correct, I have no clue how they handle it in Aussie/canada. So I'll keep my big mouth shut on that subject. Continue, to talk w your preceptor. She/He has been there and will be able to give you advice on how to handle rolling eyes without getting you in trouble. We have a charge nurse who( is rude to everyone) but if you call her on it she doesn't even realise how she appears. I've seen her break down and cry but after awhile she returns to her old ways and one of us old timers has to tell her to get a grip. I was in charge this week and handled a situation very poorly. i was right but my tone insulted the nurse. I didn't mean that and never would intentionly belittle anyone. I just came from a code(not a good excuse but true) and was a bit stressed. I apologised, but it has left bad feelings with this person. I can't do anything more about it. Venting is good, good luck.

When our floor went to computerised charting even the family commented how much time the nurses spent on the computer. Heaven forbid, your patient crashed. Now you don't think about it( year later). Click check the vitals and if there right, hit save. Once you know the system everything flows much smoother. Problem, every upgrade seems to be a downgrade and slows the system. Problem: went to chart by exception and where to chart the exception. They just wont let you do a nurses note. Computerised charting is here to stay.

Tried the dialysis nurse being responsible for prisma at first and it failed miserably. The ICU nurse wants control. Crrt: no matter what method is here to stay. I see a huge learning curve in the future. Thanks for the info.

I precept alot and I would rather you ask, then do something & find out it that it was a major mistake. I don't trust people who try to force there way thru. My advice keep asking, talk to your clinical educator, maybe u need a new peceptor. NOt everyone clicks personality wise. Worse case scenario they will stear you to a new floor, rather than lose a staff member. I had one nurse who had no self confidence. It took alot of patience but she is now one of the best nurses I know. Hang in there. Time mangaement comes w experience, stop comparing yourself to some of your peers.