Policy Archives
November 9, 2007
December 21, 2006
Upcoming Product Changes
PLEASE FIND ATTACHED UPCOMING PRODUCT CHANGES:
<<MEMO ABDOMINAL PADS.doc>> > > <<MEMO Patient Bags.doc>> > > <<MEMO Mortuary Bags.doc>>
abdominal pads
mortuary bags
patient bags
<<MEMO ABDOMINAL PADS.doc>> > > <<MEMO Patient Bags.doc>> > > <<MEMO Mortuary Bags.doc>>
abdominal pads
mortuary bags
patient bags
December 4, 2006
CRRT/ PRISMAFLEX®
CRRT/ PRISMAFLEX®
UPDATES November 2006
Using Prismaflex® on a new patient:
We all know about plugging the machine and allowing it to equilibrate with the room temperature for at least 20 minutes before installing a new filter and begin the priming process. The NEW recommendation is to plug and turn the machine on and leave it for 20 minutes. Before installing and priming a new filter, ensure that the scales have been calibrated.
Scale Calibrations:
Yes, it is still BioMed's responsibility to do the regular calibrations of all the Prismaflex® in the unit. Our responsibility is to ensure that the scales have been calibrated recently.
How to check:
1. After the machine has been turned on and performed its own self-test, the first screen you will see has the therapy information.
2. Press on the date, which is located on the right upper screen for about 15 seconds.
3. The next screen will be information about the pumps and scales. Under the scale section (lower box), look at the last column that has a heading of "PRT GR". Under this heading will be a number. Each number listed on this column should be less than 20, which indicates that the scales have been calibrated. Press exit and proceed with the installation of a new filter.
However, if you see a number 20 on this column then it means that the affected scale has not been calibrated and the machine can't be use at this time; Call biomed and asked him/her to come up and calibrate your machine.
"Time to change the Filter" reminder alarm: (It is a yellow warning light by the way)
I always thought that a filter has a 72-hour life span (unless of course if it was cut short by that dreaded clot!) and that the machine will give an advisory/reminder alarm when the filter is approaching that 72-hour time limit.
About three weeks ago, I had a patient who was on high flow CVVHDF with a blood flow of 300 mL/min. After 48 hours of run time, the yellow light came on and indicated that it was time to change the filter. Surprise!
After consulting with Lisa Magee, Gambro Clinical Specialist, I found out that the machine has two ways of keeping track of the filter life span (as set by Health Canada for filter safety regulations). One is the 72 hours time limit (that we are all aware of). The other is the amount of blood processed by the filter which has a limit of 780 litres. It is in the Operators Manual 2.0xx Page 185 for those of you who want to read more about this. Most filters currently in use in the unit would probably fall into the 72 hour time limit but if you have a patient on high flow CVVHDF with a high blood flow rates (like 300 ml/min), then expect to change the filter sooner than what you are accustomed to. Please refer to the "Advisory Set change" poster for instruction on how to get this information from the Prismaflex. I have also attached copies of these in the teal information binder used with CRRT. Just a reminder, when it is "time to change the set", it is NOT an URGENT procedure. I believe you have a leeway of 8 hours or so. Plan your day (or night) and put it on top of your priority list.
Pre filter replacement vs. Post filter replacement:
We were all told that North Americans give replacement solutions pre filter (and in fact all our machines are defaulted to pre) and the Europeans give theirs post filter. Apparently, there are centres in Canada that are now giving their replacement solution post filter! It may be coming to a filter near you. In fact, VGH in January 2007 will start using the Prismaflex® and may be using a combination of both. Nancy F. are you reading this?!
Inconsistent (and sometimes wacky) filter Ionized Calcium results:
Most of you have probably experienced this and I commend you for sending another sample before acting up on a result that you have just received.
It is currently under investigation and we need to collect more data from other hospitals and compare our current practice with theirs. Therefore, expect a change of practice in regards to the blood sampling of Ionized Calcium in the near future.
Hemodialysis Insertion Trays:
In case you are asked during a hemodialysis catheter insertion for a longer guidewire (because the one that came with the Niagara catheter kit got bent and became unusable etc. etc.) the insertion trays should come with an extra 68 cm individually packaged guide wires (the 60 cm ones is too short). However, if it is not there, the unit keeps a stock of this guide wires and they are located in the hemodynamic red carts (and in the supplies room). I have asked CSD (or SPD) to add the 68 cm guide wire in the Insertion trays.
Labeling the Dialysis and Replacement Bags:
Continue with the current practice of using the red medication stickers to indicate what medication was added into the bag, and whether the bicarbonate has been added or discarded. Distinguishing which is the dialysis and replacement bag is also encouraged. However the practice of writing on the bag with a felt marker is not recommended (and discouraged) as the ink may leach into the solution. Also, please don't forget to date and time the solutions were prepared.
Level II Prismaflex advanced troubleshooting Class:
I have spoken with Lisa Magee about this and she's thinking of offering this course sometime in April/May of 2007. I highly recommend this course to all CRRT nurses. You will receive plenty of notice when a final date has been set.
STUFF in the works:
I have just recently finished revising the following and awaiting the Physicians approval:
Calcium Infusion Nomogram (what is new: a bolus reminder which is part of the new orders and a bolus option in the actual nomogram for systemic I Ca++ of less than 0.90 mmol/l)
New CRRT orders for Citrate Anticoagulation (what is new: therapeutic dose calculation for the doctors, goal MAP and what to do should the MAP is less than goal on start up and during CRRT, a bolus order of Calcium Chloride if baseline systemic I Ca++ is less than or equal to 0.90 mmol/l)
I am currently working on revising the "CRRT preprinted orders for no anticoagulation and/or heparin anticoagulation". I am hoping to get rid of the heparin filter nomogram altogether and convince the doctors for high flow hemofiltration with no anticoagulation. Nancy F. I may need your help with this one.
And finally, CSICU will go live with their Prismaflex® on the first week of December (and yes they will be using CITRATE ANTICOAGULATION as well!) GOOD LUCK to them!! For the super users in the unit (and me), expect phone calls for assistance.
That is all for now. I apologize for this lengthy update.
If you have flex-related questions and any suggestions as to how I can support you especially the newly trained CRRT nurses, please let me know.
Thanks for your time,
Ron Bernardo
Temporary CRRT Educator
UPDATES November 2006
Using Prismaflex® on a new patient:
We all know about plugging the machine and allowing it to equilibrate with the room temperature for at least 20 minutes before installing a new filter and begin the priming process. The NEW recommendation is to plug and turn the machine on and leave it for 20 minutes. Before installing and priming a new filter, ensure that the scales have been calibrated.
Scale Calibrations:
Yes, it is still BioMed's responsibility to do the regular calibrations of all the Prismaflex® in the unit. Our responsibility is to ensure that the scales have been calibrated recently.
How to check:
1. After the machine has been turned on and performed its own self-test, the first screen you will see has the therapy information.
2. Press on the date, which is located on the right upper screen for about 15 seconds.
3. The next screen will be information about the pumps and scales. Under the scale section (lower box), look at the last column that has a heading of "PRT GR". Under this heading will be a number. Each number listed on this column should be less than 20, which indicates that the scales have been calibrated. Press exit and proceed with the installation of a new filter.
However, if you see a number 20 on this column then it means that the affected scale has not been calibrated and the machine can't be use at this time; Call biomed and asked him/her to come up and calibrate your machine.
"Time to change the Filter" reminder alarm: (It is a yellow warning light by the way)
I always thought that a filter has a 72-hour life span (unless of course if it was cut short by that dreaded clot!) and that the machine will give an advisory/reminder alarm when the filter is approaching that 72-hour time limit.
About three weeks ago, I had a patient who was on high flow CVVHDF with a blood flow of 300 mL/min. After 48 hours of run time, the yellow light came on and indicated that it was time to change the filter. Surprise!
After consulting with Lisa Magee, Gambro Clinical Specialist, I found out that the machine has two ways of keeping track of the filter life span (as set by Health Canada for filter safety regulations). One is the 72 hours time limit (that we are all aware of). The other is the amount of blood processed by the filter which has a limit of 780 litres. It is in the Operators Manual 2.0xx Page 185 for those of you who want to read more about this. Most filters currently in use in the unit would probably fall into the 72 hour time limit but if you have a patient on high flow CVVHDF with a high blood flow rates (like 300 ml/min), then expect to change the filter sooner than what you are accustomed to. Please refer to the "Advisory Set change" poster for instruction on how to get this information from the Prismaflex. I have also attached copies of these in the teal information binder used with CRRT. Just a reminder, when it is "time to change the set", it is NOT an URGENT procedure. I believe you have a leeway of 8 hours or so. Plan your day (or night) and put it on top of your priority list.
Pre filter replacement vs. Post filter replacement:
We were all told that North Americans give replacement solutions pre filter (and in fact all our machines are defaulted to pre) and the Europeans give theirs post filter. Apparently, there are centres in Canada that are now giving their replacement solution post filter! It may be coming to a filter near you. In fact, VGH in January 2007 will start using the Prismaflex® and may be using a combination of both. Nancy F. are you reading this?!
Inconsistent (and sometimes wacky) filter Ionized Calcium results:
Most of you have probably experienced this and I commend you for sending another sample before acting up on a result that you have just received.
It is currently under investigation and we need to collect more data from other hospitals and compare our current practice with theirs. Therefore, expect a change of practice in regards to the blood sampling of Ionized Calcium in the near future.
Hemodialysis Insertion Trays:
In case you are asked during a hemodialysis catheter insertion for a longer guidewire (because the one that came with the Niagara catheter kit got bent and became unusable etc. etc.) the insertion trays should come with an extra 68 cm individually packaged guide wires (the 60 cm ones is too short). However, if it is not there, the unit keeps a stock of this guide wires and they are located in the hemodynamic red carts (and in the supplies room). I have asked CSD (or SPD) to add the 68 cm guide wire in the Insertion trays.
Labeling the Dialysis and Replacement Bags:
Continue with the current practice of using the red medication stickers to indicate what medication was added into the bag, and whether the bicarbonate has been added or discarded. Distinguishing which is the dialysis and replacement bag is also encouraged. However the practice of writing on the bag with a felt marker is not recommended (and discouraged) as the ink may leach into the solution. Also, please don't forget to date and time the solutions were prepared.
Level II Prismaflex advanced troubleshooting Class:
I have spoken with Lisa Magee about this and she's thinking of offering this course sometime in April/May of 2007. I highly recommend this course to all CRRT nurses. You will receive plenty of notice when a final date has been set.
STUFF in the works:
I have just recently finished revising the following and awaiting the Physicians approval:
Calcium Infusion Nomogram (what is new: a bolus reminder which is part of the new orders and a bolus option in the actual nomogram for systemic I Ca++ of less than 0.90 mmol/l)
New CRRT orders for Citrate Anticoagulation (what is new: therapeutic dose calculation for the doctors, goal MAP and what to do should the MAP is less than goal on start up and during CRRT, a bolus order of Calcium Chloride if baseline systemic I Ca++ is less than or equal to 0.90 mmol/l)
I am currently working on revising the "CRRT preprinted orders for no anticoagulation and/or heparin anticoagulation". I am hoping to get rid of the heparin filter nomogram altogether and convince the doctors for high flow hemofiltration with no anticoagulation. Nancy F. I may need your help with this one.
And finally, CSICU will go live with their Prismaflex® on the first week of December (and yes they will be using CITRATE ANTICOAGULATION as well!) GOOD LUCK to them!! For the super users in the unit (and me), expect phone calls for assistance.
That is all for now. I apologize for this lengthy update.
If you have flex-related questions and any suggestions as to how I can support you especially the newly trained CRRT nurses, please let me know.
Thanks for your time,
Ron Bernardo
Temporary CRRT Educator
November 11, 2006
MAR Changes Effective Nov 15th
October 11, 2006
Silence Kills : The Seven Crucial Conversations in Healthcare
All too often, well-intentioned people in healthcare institutions choose not to speak up
when they’re concerned with behavior, decisions, or actions of a colleague. For example,
• A pharmacist receives a prescription that is clearly
incorrect but fills it anyway because the doctor has
been hostile when challenged in the past.
• A nurse quits reminding a colleague to put up the
safety rails on a child’s bed because she decides it’s
not her job to deal with her.
• An administrator is reluctant to drive quality
improvements in the hospital because some
doctors have been uncooperative with past
initiatives.
The Seven Crucial Conversations in Healthcare
David Maxfield, Joseph Grenny, Ron McMillan, Kerry Patterson, Al Switzler
October 9, 2006
Wound Link Workshop Online Sign Up
If you want to attend the Wound Link Workshop and do not require staffing replacement, you can register online quickly and easily.
If you have never registered for a course online, you need to sign up first. Make sure you have your employee number available.
1. Open Internet Explorer and type in ccrs.vch.ca
2. If you have never registered online for a course before, you need to sign up. Have your employee number available (from your pay stub). To start, click on ‘Sign Up’ at the top of the page.
3. Choose the appropriate option for your employment status and click ....
