RehabNurse asked me a question: did the ICU help me get into my new niche, dialysis. The short answer is yes, I did.
The slightly longer answer is that in many ICUs, patients require dialysis just like anywhere in the hospital and because they are so critically ill, it must be slow (i.e. 24 hour) dialysis. It's called CVVHH or CRRT...continuous renal replacement therapy. Which means the ICU RNs run the machines all day/night until one of two things happen. (The dialysis nurses actually understand the machine, test it, maintain it, and handle all access between the machine and the patient.) (There are excellent reasons for this division of labor.)
Reasons for stopping slow dialysis are: the drug the patient ingested is gone, their kidneys woke up and they're now making/clearing urine or the patient's heart (read: blood pressure and HR) can tolerate a regular speed hemodialysis treatment. Then the dialysis RN comes in and does the specified hemo treatment at the ICU bedside.
I loved doing CRRT while I was in the unit. Some ICU nurses love the ICU because of the adrenaline. I loved it for the multiple organ system failure, the very sickest of the sick. When we're still doin everything possible, and one system after another fails, dialysis becomes inevitable as do pressors. My unit's resource nurses knew I loved the 1:1 CRRT patients, so I got them often. (Some ICU nurses hate doing CRRT.)
But anyway. RehabNurse's question, and doing my BLS renewal today got me thinking about nursing specialties. I got the dialysis version of BLS today, which is new to me.
I've gotten the rehab/SCI/TBI version of BLS, which is BLS plus How To Do Compressions On A Patient In a Halo and Love Of God, No Chin Tilt, Jaw Thrust Only!!!
The critical care version of BLS: Yawn. Just tube 'em.
The dialysis version included: Pump the blood back manually. Put their legs up, open the saline wide. If it's an air embolism, it's entirely your fault...left trendelenberg and pray. And if you shock 'em while they're dialyzing, you'll fry the machine.
What's your version of BLS?
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3 comments:
MY version of BLS -
...
ACLS
lol
The Renal Association is involved in many joint activities, and liaises with many other relevant groups. Some of the organisations with which we share formal committees are: - renal exam course
The Committee is established to ensure that the College is properly briefed on issues in the specialty and the Renal Association is briefed on College plans and policy. It will advise its parent bodies, or other organisations on their behalf, on matters of mutual interest. These will include; nephrology exam
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