A few ?'s for Dialysis Nurses from LTC RN

  1. Hello,
    Our Long Term Care Facility has two Dialysis patients. I have not had much experience with Dialysis patients and was wondering what is the best way to care for the cath, also what about giving morning meds to the patient right before their treatment? Sorry, One more question! Do you draw labs for facilities? I have seen nurses ask to have labs drawn on a patient while at Dialysis, I was wondering if this was the norm?
    Thanks!
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  2. 13 Comments

  3. by   burger914
    Sorry about the care of the cath question..I seen my question answered in a previous post.
  4. by   jnette
    Quote from burger914
    Hello,
    Our Long Term Care Facility has two Dialysis patients. I have not had much experience with Dialysis patients and was wondering what is the best way to care for the cath, also what about giving morning meds to the patient right before their treatment? Sorry, One more question! Do you draw labs for facilities? I have seen nurses ask to have labs drawn on a patient while at Dialysis, I was wondering if this was the norm?
    Thanks!

    Hi there!

    OK.. there are several good threads/posts here for you as you have probably seen by now regarding LTC care of dialysis pts.

    As far as labs, the ones we draw at dialysis are for our own use in recognizing changes in out patients, for example, their hct./hgb., K+ levels, cal/phos levels, etc. That's how we gage what meds we give or hold, how to advise on nutritional issues, etc.

    I have never been asked to draw labs for the LTC, as they always draw their own if problems arise. When the patients come to us, it is for dailysis and renal issues only. We will, on occasion, ask the LTC to monitor their diet, or hold certain supplements, etc. when electrolytes are off.. ie., if we notice on our labs that their calcium or potassium is elevated, etc.

    Hope that helps.
  5. by   HEARTOFWORSHIP
    For information on which drugs do or do not dialize out during dialysis, a group called Bone Care International publishes a very nice poce size book called "dialisis of drugs" which they will send you for free. The phone number for this company is 1-888-389-4242. They also make nice wall posters of the drug chart which is also free.
  6. by   theresa_b
    Quote from burger914
    Hello,
    Our Long Term Care Facility has two Dialysis patients. I have not had much experience with Dialysis patients and was wondering what is the best way to care for the cath, also what about giving morning meds to the patient right before their treatment? Sorry, One more question! Do you draw labs for facilities? I have seen nurses ask to have labs drawn on a patient while at Dialysis, I was wondering if this was the norm?
    Thanks!
    At our facility we have several LTC pts. We are frequently asked to draw labs for the LTC facility they are residing at. We also get requests from other physicians and home health nurses. However, our policy is that we only draw labs that are required by our facility and nephrologists. The reason being that when we tried to draw for the many requests we received, we were unable to make sure that all of the various results got to the right places. As we were the ones doing the blood work, then we were the ones responsible for everyone getting the results....and it was a logistics nightmare. What we CAN do, is send our monthly lab results home (or back to the LTC unit) with the pt. Oftentimes, our labs corrilate with what they needed drawn and it makes for less bloodwork drawn from that pt.
    theresa
  7. by   Hellllllo Nurse
    Many pt's B/P will crash if they take antihypertensives prior to getting their dialysis. There have been a few incidents like this where I work. Orders are to hold B/P meds prior to dialysis, but they are inadvertantly given. Pt then experiences symptomatic hypotension while on tx.

    This has also happened when LTC pts have been given sedatives prior to dialysis, Whenever we've had a LTC pt's B/P crash on tx, I've called the LTC, after stabilizing the pt. I'll usually find out they were given B/P meds or a sedative that morning.
  8. by   AmyLiz
    Our facility doesn't draw labs for LTCs or other doctors, but I've seen them share lab reports so the same lab doesn't have to be done twice.
  9. by   kdhnursern
    At our facility, we're not allowed to take orders from any doctor other than our nephrologists. We do fax lab results to nursing facilities if they request them and we fax them to primary care doctors who have requested them, too. But they are only the labs that we ourselves need done. Also, one of our pts is on an IV antibiotic for an infetion not renal related and we leave the needles in after his tx is done and send him downstairs to the MS nurses who have the order for that. Then they send him back up to us after his antibiotic so we can pull his needles and tape him up.
    With our LTC pts, the dietician usually gets in touch with their LTC facilitites to get their diet and fluid restrictions straight.
    I used to be in LTC and have given the DON there a lot of information on renal pts as they have 2 very noncompliant ones. Those pts were SO thankful! :chuckle
  10. by   donmomofnine
    We have one resident on dialysis and knew zero about it, so we developed a dialysis communication form to be taken to dialysis treatment and returned with the resident. We have learned much from the dialysis nurses from this! They also did an inservice for staff and from the info they brought I put together a policy and procedure for care of dialysis residents. The medication booklet that was mentioned is also very helpful.
  11. by   jnette
    Quote from donmomofnine
    We have one resident on dialysis and knew zero about it, so we developed a dialysis communication form to be taken to dialysis treatment and returned with the resident. We have learned much from the dialysis nurses from this! They also did an inservice for staff and from the info they brought I put together a policy and procedure for care of dialysis residents. The medication booklet that was mentioned is also very helpful.

    Bravo !!! Kudos to you !

    I'd like to see much more of this done.
  12. by   donmomofnine
    I think the psychosocial aspects of dialysis treatment were the most fascinating part....the honeymoon phase and then the emotions that occur once the resident realizes that this dialysis thing is going to be a permanent part of their lives! I really saw this with our resident. The state was wondering about her increased use of a sleeping pill for the last month, but interestingly enough, this happened as her attitude toward her dialysis changed. The honeymoon was over. There is always so much to learn! We have so much to share with each other and our residents (patients) benefit!
  13. by   NEPHRONRN
    In The 17 Yrs Ive Been In Hd
    It Is Allways Been Understod That The Hemo Cath Should Never Be Used Unless The Pt In Cardiac Arrest.

    You Must Remember That Hd Caths Are A Life Line.
    If They Are Not Used And Then Flushed Correctly They Could Clot
    And Might Have To Be Changed Or Declotted
    And These Options Cost A Ton.

    As Far As Cleaning Them The ,same Thought Applies
    Dont Touch .

    Have A Good Day I Hope Ive Helped
  14. by   jnette
    Quote from NEPHRONRN
    In The 17 Yrs Ive Been In Hd
    It Is Allways Been Understod That The Hemo Cath Should Never Be Used Unless The Pt In Cardiac Arrest.

    You Must Remember That Hd Caths Are A Life Line.
    If They Are Not Used And Then Flushed Correctly They Could Clot
    And Might Have To Be Changed Or Declotted
    And These Options Cost A Ton.

    As Far As Cleaning Them The ,same Thought Applies
    Dont Touch .

    Have A Good Day I Hope Ive Helped
    Couldn't agree more.

    We always tape the caps of the cath lumens to ensure they are not accessible, or at least cause one to question whether or not they should be messing with them.

    These caths are also easy to invite sepsis, it is essential that they not be opened or used for anything but dialysis. As it is, the risk is great because we access them 3 times a week. Even with the utmost care, it is always a risk...

    We do our own dressing changes, no need for LTC to worry about them. Main thing to know is keep the cath area clean and dry. (food, crumbs,juice, etc.... watch for these getting near the caths)

    As for fistulas and grafts, just be careful to never use the arm for a BP or allow tight or restrictive clothing/jewelry on that arm. Protect the fistula/graft as it, too is the patient's lifeline.

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