"How much do you want off today?"

GeauxNursing · Sep 28, 2011

We are in a pilot project using the Crit-Lines to monitor our fluid removal and the body's response. What a pain these things are! But it allows you to see how your pt is responding to the fluid removal. It displays a graph as the treatment goes, based on blood volume change, using the hematocrit as a gauge. The crit-line instructor has been here many times trying to get everyone on board. The CNs are going around doing frequent rounds and calculations, trying to make sure no one is pulling too fast. The graph will basically tell you when someone is going to crash, due to excessive fluid removal in the time allowed.

Our MD is not in the "less is more" school of thought; we go for the max allowed every time, otherwise we have to do an AOR. With these crit lines, however, there are guidelines that allow for a decrease in the UF goal as the calculations reveal impending crashes and BP drops.

We have moved away from the "how much do you want to pull today" as it caused too many headaches for CNs and MDs. Company basically said if you don't go for the full amount (within our hourly limits), you are taking on the role of an MD and deciding what the pt can tolerate, which is well beyond our scope of practice. Duh.

Trauma Columnist · Sep 29, 2011

I work in several FMC units and they have just bought the crit-line company so supposedly crit lines are coming back. We had them in several units about 3 years ago but we (APNs) never really received much education regarding their use and then it was decided they weren't useful.

As an APN, I'm the one doing the ordering and explaining my rationale to patients.

I do think crit lines will be helpful - however, they do not take into account a patients overall condition.

AlabamaBelle · Oct 9, 2011

I work in pediatric dialysis and we have been using the Critline monitoring for over a year now. They are a pain at first, but once you learn how to use the information you are given - they are a very useful tool in therapy, but they are only a tool.

For our patients who still have residual renal function, we pull at a more conservative rate, approximately at 3% to 5% change per hour. For no residual renal function, 5% to 8% an hour. Of course, monitoring their blood pressure is essential. We are finding a lesser rate of IDMs as a result of plotting out the appropriate changes per hour.

They are helpful, but they are no substitute for good, sound nursing judgment. I ask the kids frequently how they are feeling and an eagle eye on the blood pressure.

Trauma Columnist · Oct 9, 2011

WarEagle - thanks so much for that perspective.

Fresenius bought out the crit-line company so their newest machines come with the ability to have the crit-line in the machine. However, the units where I go that have the new machines don't have the module installed for the crit-line.