Continuous elimination methods in burn patients from the point of view of a nurse.

Continuous elimination methods are part of complex therapeutic methods used in critically ill patients after burn injuries. We have been using CVVH (continual veno-venous hemofiltration) in our center since 1995. We use CVVH in patients after burn injury who present with systemic inflammatory syndrome, multiorgan dysfunction or multiorgan failure. From 1995 till 2001, elimination was performed under the supervision of an intensive care unit nephrologist. In recent years we have provided CVVH to burn patients independently. A nurse places sets in the device, flushes the sets with saline with heparine and subsequently drains this off into a collecting bag. After the device is tested it is ready to be used on a patient. The nurse calls a MD and under his supervision begins the elimination. Elimination parameters are set by the attending MD, and the nurse has a full written record of this throughout the elimination. The MD is informed of any complications during the elimination. If an alarm goes off the nurse initiates correction in co-operation with the MD. During the whole procedure the patient is clinically observed, and changes of his status are noted in a shock record and elimination protocol. Since 1995, 60 eliminations have been performed, occupying a total time of 7,400 hours. The work is very demanding and interesting; the patient's status improves significantly.