Eastclif

In the CVICU where I work, the nurses do everything with the CRRT. But first you have to attend inservice classes, and then your name goes on the list of nurses in the unit who can do CRRT. (We do the same for IABP and VADs.) If we have problems we can't handle, which is a rare occurence, we call the Prisma rep. We always nurse the patients 1:1. When we first started using the Prisma, in the early 90's, we would have 2:1, but that didn't last long!!! If and when the patient is stable enough for hemo, the dialysis nurses take over, and bring their portable equipment, which we have nothing whatsoever to do with.

I think there are two issues here. Having charts completed properly before going off duty is very important, and if necessary, I think the nurse should stay past her shift to make sure all meds are signed, vitals charted, balances done and notes complete. It is something that only the nurse that gave the care and medications can do, and the information is essential in order for the medical team to make a proper assessment and adjust the treatment plan. But the reality is that there are always nurses who are sloppy in this department. They need to be told directly to clean up their act. And if that doesn't work, it should be taken further. On the other hand, and I see this all too often where I work (CV-ICU), is that many nurses feel their work is not done unless the patient is extubated, deep lines out, washed and sitting up in a chair when the day nurse arrives, EVEN IF the patient is not really ready, and could benefit from the lines being in for a couple more hours. For example, taking out the PA catheter and art line when the patient is still on a bit of Nipride. This means that the main IV and antibiotics must be given in the same line as the Nipride (with potential peaks and troughs in the BP, and the BP is not being properly monitored). The patient can't go to the ward on Nipride, so why rush to pull out the lines??? It only takes a minute (5 for the art line), and can be done more safely when the extra meds are off. I see this as a case of nurses doing things for other nurses and not for the patient. The theory is that it speeds things up for transferring patients to the ward, but they can't go till there are beds available on the ward (10 or 11 am) - it's not as if they are being rushed out at 8 am. Does anyone else have this problem, which is kind of the opposite end of the spectrum from leaving charting undone?? The bottom line is that everything we do (or don't do) should be in the patient's best interest, and neither of the practices serve that purpose.