![]() In order to gather further details about the alarm, the employees at the ROCC’s Rail Operations Information Center (ROIC) desk - the staff tasked with messaging information and delays to riders and coordinating Metro’s station managers - put in a call to the station manager at Dupont Circle at 9:08 pm. A source tells GGWash that some alarms do include their specific locations, but not all of them. Unfortunately for the staff at the control center, this fire alarm did not include information that would prove useful: the location of the alarm and what the area it was located in was used for. For unknown reasons, the arcing failed to cause a power breaker to trip, which should have disconnected the cable from its power source and would have limited further arcing and smoke.Īt 9:07 pm Saturday (July 30) a fire alarm went off at Metro’s Rail Operations Control Center, the nerve center of the rail system. While the Metro and Washington Metrorail Safety Commission (WMSC) investigations into the fire, as well as the agency’s response, are ongoing, a source tells Greater Greater Washington that the source of electrical arcing was one cable of a three-phase 480-volt power distribution line along the inside of the Red Line tunnel between Woodley Park and Dupont Circle. The agency implemented a bus bridge for the remainder of service Saturday, all of Sunday, and Monday morning from 5 am until 11 am. The track fire during the evening of Saturday, July 30, caused Metro to suspend service on its Red Line between Van Ness and Farragut North until 11 am on August 1, about 38 hours later. At the time a Red Line train was traveling from the Woodley Park to Dupont Circle stations, the Metro Rail Operations Control Center (ROCC) was still attempting to determine the location of a recently-activated fire alarm and they apparently weren’t aware of the emergency. Metro officials unknowingly sent a Red Line train with riders on board towards a track fire, according to agency statements and information provided to Greater Greater Washington. Depending on the institution, infectious disease, Heme/Onc and GI/GU may be following the patient as well as Critical Care and Nephrology.Red Line train at Grosvenor-Strathmore station by Ben Schumin licensed under Creative Commons. Other complications the nurse should be aware of and aim to prevent include but are not limited to, infections, bleeding, hypotension, electrolyte imbalances, All of these complications need to be monitored closely and the bedside nurse should utilize the multiple services consulted for the patient for optimal prevention and treatment. Each circuit can hold approximately 150-250 mL blood, which can add up, especially if circuits are replaced 2-3 times a shift. If the machine stops cycling and appears to be trying to clot, the patient’s blood should be returned and therapy discontinued with the current circuit. The bedside nurse should always have saline flushes and heparin (or the anticoagulant ordered) within reach if the machine decides to clot off and stop cycling the blood. Circuit clotting needs to be closely monitored for and anticipated during the treatment. ![]() Lab orders and ABGs are followed based on physician preference, patient condition, and/or for any acute change.Ĭlotting is the #1 complication during CRRT, whether it is the circuit clotting or the line itself clotting off. Blood flow rate can be adjusted to help prevent clotting, and dialysate rate is usually calculated depending on patient weight and electrolytes. Patients will either run with a positive, negative, even, or zero fluid balance. CRRT machine orders will be given by the nephrologist and can be adjusted during the treatment. The amount of required heparin will be labeled on each port hub. Once the line is established, it needs to be anticoagulated as soon as it is inserted. There is a red and a blue line, but it will both be venous and should never be arterial. ![]() ![]() This is because it is pump-driven and incorporates venovenous extracorporeal circuits. The patient will need a double lumen dialysis catheter.įistulas are common for established dialysis patients but cannot be used with CRRT. So, the nephrologist placed orders for CRRT what will you need? First things first, access needs to be established.
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