Cannulations and Life-Sites

[Hellllllo Nurse]

I am new to dialysis. In the training films I watched for orientation, nurses and techs were shown cannulating bevel-up, then rotating the needle in the graft so that it would face bevel-down for the tx. Also, bevel-down cannulations were shown. The film stated that bevel-down is the preferred method for cannulation.

Everyone just does it bevel-up and leaves it that way where I work.

Do you cannulate bevel-up or bevel down?

Is bevel-down really better?

And Life-Sites...ugh. They are such a PIA. It is so hard to find the hole, and they run poorly. None of our pts with Life-Sites can run at a BFR any faster than 250.

A company rep gave an inservice today where I work. She says that BFR on Life-Sites should be 500!

None of out Life-Site pts can run at that rate.

What about yours?

[jnette, ASN, EMT-I]

Hellllllo... we work for the same company.. it just boggles my mind how there can be so many variences ! Why is it that we use heparin pumps and you guys don't get to? I don't understand this. If it were a different company, I could swallow that. And we aren't even doing reuse anymore.. even less reason to use the pumps ! )..except, of course not wanting the pt. to clot off during tx.)

Are they hounding you all to use the saline SPARINGLY? (and by that I mean not for the PATIENT'S sake, but for the pennypinchng).. just curious.

[Hellllllo Nurse, BSN, RN]

A couple weeks ago, some big-wigs in suits came down from some corporate office and told us we are not to use heparin pumps, or any heparin during tx anymore, just the bolus before starting tx. I don't know what the deal is.

they don't get on us about saline use, but will not let use use hypertonic, even though the orientation films i was shown said to and in what situations.

Seems like using hypertonic on pts to prevent crashing would be a lot better than loading them up w/ regular saline!

In Canada, they use mannitol and albumin to prevent crashing. Way to expensive, it would never be done here.

Also, I was promised $3./hr Saturday diff, but have never received it. They keep saying they will pay me all of it "next check", but it has never shown up.

I am getting tired of this company already.

Emphasis is on getting pts in and out as fast as possible. To Hell with quality of care.

I am exhausted working at such as constantly frantic pace. It's rediculous.

[jnette, ASN, EMT-I]

What about your DOCS ? They are the BIG part of the governing body ! Our docs INSIST on what they want, and don't allow the "company" to tell THEM !

It is PROTOCOL (from our doc) to use hypertonic and/or mannitol.

It is protocol to use heparin pumps on those who have a tendancy to clot during tx.

A $3.00 SATURDAY pay differential??????? WOW.. never heard of THAT here ! hmmmmmm... gonna ask about that one !

[babs_rn]

HellllloNurse, what company do you work for? I want to make sure I never work for them....

Babs

[Hellllllo Nurse, BSN, RN]

Babs, I work at Fresenius owned unit.

But, different units owned by that company are run differently from one another, pay is different, staffing etc. is different, number of pts is different, depending on the geographical area and the medical directors of any particular unit..

[babs_rn]

Still, I have yet to hear a single good word about FMC.

Still wondering about Gambro. As much as I like the company I work for, there are just not enough patients in our clinic for me to keep my full-time benefits (barely even to get part-time benefits) so I've been floating to Atlanta(194 miles away) one day a week (travel time pay and mileage reimbursement helps a LOT) ...but they just hired a nurse so now I'm sorta stuck. I could work TTS in Statesboro (50 miles away) - because they have an RN who is deployed right now -on top of my MWF, but who wants to work 6 days a week every week just to make ends meet? There's a Gambro clinic about 60 miles away that's hiring and if there's one thing I've learned in my vast experience, it's that I don't want to do anything other than dialysis as a nurse. I gather they don't have a relocation incentive for nurses (figures) so it would be for me to commute for the next year or so before I can afford to move, but it would be worth it to do that rather than traipse all over the state at beck and call begging for whatever opening I can get (which you KNOW would be only on Saturdays). I love my patients and my staff and I really do NOT want to leave but I'm just waiting to see what the good Lord has in store at this point. I just wondered what kind of a company Gambro is to work for. I posted the question on another thread but no one has responded yet.....

[Northern nephron]

Hi, the unit where I work we needle bevel up and switch to bevel down once treatment is established.