Advice: Profile or Not? - page 2

I have a question for you experienced HD nurses. I have been working in an HD clinic for 3 months (newbie!) and need some advice. Here Goes: New HD patient, did not know he was ESRD until... Read More

  1. Visit  anurseadvocate} profile page
    0
    I congratulate you on being an advocate for your patient. The behavior of your charge nurse is something I have seen alot -- a lack of respect for the patient, a lack of understanding of the diaysis treatment... This is the problem with incenter care -- taking off large quantities of fluid over a short period of time --- It is obvious, from your statement, that there might be other patients having other problems and if the charge nurse can not give advice, supervision and teaching / education of other RNs perhaps you need to do something more to protect your patients. Perhaps you can ask for an inservice on various aspects of care.. especially considering we don't know all the medical problems/illnesses this patient has which might make a big difference.. the dialysis treatment is not cookie cutter and each patient is an individual with individual needs...
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  3. Visit  Fins Up!} profile page
    0
    traumaRUs

    could you post the link to the literature about the profiles.

    "latest literature proves that when you use a profile, you are stressing the heart too much".

    thanks!
  4. Visit  traumaRUs} profile page
    0
    I posted the original citation March 30th:Nature Publishing Group : science journals, jobs, and information this helps.
  5. Visit  anurseadvocate} profile page
    0
    Many facilities use sodium profiliing, however, recently I have read a few articles where they are advising not to use such -- and they are finding more problems. from recall, related to cardiac --if TraumaRU, or someone can approve, I will look back and post the article --- It is tough removing so much fluid in such a short time -- some units will have the patient come in for an extra treatment, which the physician can order and with supporting rationale, Medicare will cover --
  6. Visit  gcat626_RN} profile page
    0
    Why don't you try for a smaller UF goal per tx, say 3500-3800, and have the patient come in for extra treatments?
  7. Visit  traumaRUs} profile page
    0
    Nowadays, the UF formula our practice uses (as do many others) is no more than 13ml/kg/hour of fluid removal. There have been several articles about sudden cardiac death while on dialysis. If you have ever had this happen (and I have), it is a scary bad deal and you don't get a second chance.

    Extra treatments sound good in theory, but dialysis units have to have space and that is not always the case.
  8. Visit  gambutrol} profile page
    0
    I agree with fluid restriction education and Na restriction in diet. It's really hard pulling that much fluid in a certain amount of time. Maybe an extra treatment in between his regular treatment schedule so that you're not pulling too much fluid per treatment. Personally, I like UF profiling esp for those who have poor refill.
  9. Visit  Rayden} profile page
    1
    Quote from traumaRUs
    Nowadays, the UF formula our practice uses (as do many others) is no more than 13ml/kg/hour of fluid removal. There have been several articles about sudden cardiac death while on dialysis. If you have ever had this happen (and I have), it is a scary bad deal and you don't get a second chance.

    Extra treatments sound good in theory, but dialysis units have to have space and that is not always the case.
    Based on your contributions and my further reading, we have also implemented this practice in our renal unit. Before our policy was a maximum UF rate of 1000mL/hr, but now we follow the 13mL/kg/hour guideline.

    If there's still more fluid that needs to be pulled off, we schedule the patients on extra treatment the next day.
    traumaRUs likes this.


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