Thank you! And very impressive summary of the whole procedure (#1)
I apologize for the confusing questions, again, I really know next to nothing about dialysis. Less complicated question: it is my understanding that all, or at least most, dialysis pts have fluid removed as part of the standard procedure, as you said in my ? about ultrafiltration. What is confusing me is recently I have seen progress boss with statements such as "pt went to dialysis but was unable to tolerate it and required ultrafiltration" or "pt received dialysis but continued to have xyz imbalance and required ultrafiltration." For these pts the d/c summary will often say something like "received dialysis with ultrafiltration" as though the ultrafiltration is sort of a fancy add-on. But from what you are saying, if I am reading it correctly, ultrafiltration is just the word for the way fluid is removed during dialysis, which is part of the routine procedure for many (most? All?) pts. So why is it suddenly being described as though it is something extra; actually the tone of most of the notes is that the pt required ultrafiltration due to being gravely ill with poor response to dialysis. Incidentally, I did not ever see this term mentioned in any notes until the last 6-12 months. Soooo...is this just a word for part of your normal procedure? Or is it something extra and unusual?
Also quick question: what makes a fistula needle different from others (aside from the very large gauge)? (I.e.: Huber needles are distinguished by the bend, they are non-coring which is necessary to maintain the integrity of the port)
And speaking of needles....you said you flush the caths with saline...(I assume you flush the fistula with saline before deaccessing?) I have always been told that one of the reasons we non-dialysis folks are never ever to use a dialysis cath except in a code is that they are filled with potent anticoagulent at an exact volume depending on cath length/size that must be removed prior to use, and when the caths have been used in codes or hospice (rarely) I have always seen them draw a large waste prior to use for this reason. Is this true?
I do understand that the red/arterial line returns "cleaned" blood, hence the term arterial. What has always confused me is whether that arterial line ends in an actual artery, like an arterial line for bp monitoring? One reason I ask is that occasionally in hospice if we are desperate we use a dialysis cath to give comfort meds if the pt is actively dying, needs the meds badly and has absolutely no alternative access. Most of us draw a big waste (see above) and only use the blue line for this,with the rationale that you only give meds through venous access and never arterial. But I am getting the feeling that they would both actually be safe to use for this, that in dialysis you distinguish between venous/arterial for removal/return and actually probably do give some meds/lytes/fluid thru the arterial side. Am I correct that they are both basically central (mixed) venous/atrial access?
You asked what I wanted to know about accessing the caths. I assume that you remove the cap and clean the end using sterile technique and alcohol like any central line. As above, do you then draw a waste, or just flush? And then is it as simple as hooking up the lines from the machine to the cath, again like a central line? You said there are a lot of steps so do you do anything that is not done when accessing and connecting a central line to an IV infusion?
Again feel free to ignore if you are bored or if I am just beyond help
Honestly this has been my one weak spot that I have been very curious about. You have inspired me to ask all my burning questions.
EDIT: honestly, I really am a moderately experienced, competent nurse and I really have a lot of clinical knowledge about most subjects. Except this one. But, please don't take this as a reflection of my overall understanding of clinical subjects. Yikes!