dialysate question - page 2

Hello all: A question. Please explain the dialysate issues surrounding the following situation. If a patient, who is prescribed K3 Ca 2.5 does not get it, due to whatever reason, i.e. staff... Read More

  1. by   RRN
    Quote from mommatrauma
    Personally I believe you are paranoid....and I don't think there is anything wrong with question asking...that's how people learn, whether they are healthcare professionals or not...Also, this person states they are a patient advocate...personally, I would hope that we all are..thats our duty. You sound very defensive? Why is that? I say its better to ask questions and get informed answers than not to ask and to just act like you know what you are talking about. I give kudos to imperial for at least coming to trained professionals that can give these such informed responses. Also, I feel that if you feel threatened by this person and don't feel it appropriate for them to ask "leading questions" simply don't answer them...Didn't your mom ever tell you if you have nothing nice to say, don't say anything at all?


    First of all my mother died when I was three years old.. Of acute renal failure.. I guess you missed my post stating that the OP here continually infers that nurses, techs, etc are making serious mistakes often..


    And I'd say to you.. Why aren't you answering her question..

    Because if the acid wasn't plugged into anything any dialysis machine would beep..

    This person never takes our advise so why is she asking for it??

    I'd suggest you read some of her other questions before you make an assumption here.

    P.S. People learn when they take honest correct information and utilize it..
    Last edit by RRN on Apr 2, '05
  2. by   jnette
    imperial... I must agree with the above.. there is NO WAY the machine would even run if the acid jug was not hooked up... (unles in "bypass")..period. Cannot happen.

    Some units have central lines from which the bath is coneected to the machine.. no jugs needed. Since the patient inquired about the second jug, then I'm assuming this unit uses jugs for both acid and bicarb. HOWEVER.. again, you cannot run a machine without the acid wand in the acid jug.. as stated above, you can't even put it into dialysis mode without it being connected. It is the acid which brings the machine up to conductivity in order for it to go into diaysis mode.

    That said.. when you go to change out a jug.. if it's getting low, or after a previous patient running on a different K+ bath, you hit the yellow "bypass" button.. this put the machine into "bypass mode".. the dialysate bypasses. But this bypass mode will alarm after five minutes of being in "bypass".. to let you know that you are still in bypass. This is the only way you can run the machine with an acid wand temporarily out of the jug. You cannot run someone for 40 minutes without being hooked up to acid.. the machine would alarm continuoulsly after that initial five minutes until you fixed the situation.

    Would any harm come to the patient? No. Basically, you would just be recirculating the blood.
    Last edit by jnette on Apr 2, '05
  3. by   RRN
    Quote from Mccm219
    What type of machine are your running would let you run it without adding the prescribed K3 Ca 2.5 ?


    Probably one of the wash tubs from the late 70's early 80's
  4. by   RRN
    Quote from jnette
    imperial... I must agree with the above.. there is NO WAY the machine would even run if the acid jug was not hooked up... (unles in "bypass")..period. Cannot happen.

    Some units have central lines from which the bath is coneected to the machine.. no jugs needed. Since the patient inquired about the second jug, then I'm assuming this unit uses jugs for both acid and bicarb. HOWEVER.. again, you cannot run a machine without the acid wand in the acid jug.. as stated above, you can't even put it into dialysis mode without it being connected. It is the acid which brings the machine up to conductivity in order for it to go into diaysis mode.

    That said.. when you go to change out a jug.. if it's getting low, or after a previous patient running on a different K+ bath, you hit the yellow "bypass" button.. this put the machine into "bypass mode".. the dialysate bypasses. But this bypass mode will alarm after five minutes of being in "bypass".. to let you know that you are still in bypass. This is the only way you can run the machine with an acid wand temporarily out of the jug. You cannot run someone for 40 minutes without being hooked up to acid.. the machine would alarm continuoulsly after that initial five minutes until you fixed the situation.

    Would any harm come to the patient? No. Basically, you would just be recirculating the blood.
    Jnette,

    I believe the OP wanted to know if NOT getting the 3K+ bath for the first 40 minutes of treatment would affect the patient..

    Yes, it might. K is dialyzed out. The standard bath is 2.5K+. The patient probably had a low K level from the last blood draw.. So they needed a 3K + bath to compensate for that fact..

    I don't believe 40 minutes would lower their K dangerously.. Unless they get a K level drawn stat and resulted with each treatment and their bath adjusted with each treatment then they went some treatments without a change in their bath.

    Now people that's probably not the answer the OP wanted but it's the best answer... Again I believe this OP is looking to point fingers and that is MHO and as everyone know along with an a**ho*e we all have em..
  5. by   imperial
    Quote from jnette
    imperial... I must agree with the above.. there is NO WAY the machine would even run if the acid jug was not hooked up... (unles in "bypass")..period. Cannot happen.

    Some units have central lines from which the bath is coneected to the machine.. no jugs needed. Since the patient inquired about the second jug, then I'm assuming this unit uses jugs for both acid and bicarb. HOWEVER.. again, you cannot run a machine without the acid wand in the acid jug.. as stated above, you can't even put it into dialysis mode without it being connected. It is the acid which brings the machine up to conductivity in order for it to go into diaysis mode.

    That said.. when you go to change out a jug.. if it's getting low, or after a previous patient running on a different K+ bath, you hit the yellow "bypass" button.. this put the machine into "bypass mode".. the dialysate bypasses. But this bypass mode will alarm after five minutes of being in "bypass".. to let you know that you are still in bypass. This is the only way you can run the machine with an acid wand temporarily out of the jug. You cannot run someone for 40 minutes without being hooked up to acid.. the machine would alarm continuoulsly after that initial five minutes until you fixed the situation.

    Would any harm come to the patient? No. Basically, you would just be recirculating the blood.
    once again, thank you all who provided information. I must say that recently I visited an elderly patient at a unit, after driving them there.. The staff were overworked, running like crazy and I, better than anyone, realize and KNOW that staff do not intentionally make mistakes. I appreciate the hard work that staff do on those that I am connected with. I must address whoever stated that I am looking for mistakes that staff make, etc.. NO WAY!!.. trying to understand. I had the pleasure to attend one care plan meeting of a patient of whom I work closely with, as a patient advocate/ombudsman (volunteer) and must admit that the information received is more detailed here at this site. Thx...
  6. by   RRN
    Quote from imperial
    once again, thank you all who provided information. I must say that recently I visited an elderly patient at a unit, after driving them there.. The staff were overworked, running like crazy and I, better than anyone, realize and KNOW that staff do not intentionally make mistakes. I appreciate the hard work that staff do on those that I am connected with. I must address whoever stated that I am looking for mistakes that staff make, etc.. NO WAY!!.. trying to understand. I had the pleasure to attend one care plan meeting of a patient of whom I work closely with, as a patient advocate/ombudsman (volunteer) and must admit that the information received is more detailed here at this site. Thx...


    Excuse ME????? Go and read some of your previous posts..You've just implied here in this very post that staff make mistakes... "KNOW that staff do not intentionally make mistakes" What DOES that mean??????

    The best way to understand something is to do it.. As for the running around it's a dialysis culture.. Ever been to a fast food restuarant???

    And I watch it and participate in it 4 days a week and am amazed myself and commented on the fact that if one looks at it from that prespective only then they don't understand it at all..

    P.S. I think at 42 minutes the patient would have croaked....Maybe....
    Last edit by RRN on Apr 2, '05
  7. by   jnette
    Quote from RRN
    Jnette,

    I believe the OP wanted to know if NOT getting the 3K+ bath for the first 40 minutes of treatment would affect the patient..

    Yes, it might. K is dialyzed out. The standard bath is 2.5K+. The patient probably had a low K level from the last blood draw.. So they needed a 3K + bath to compensate for that fact..

    I don't believe 40 minutes would lower their K dangerously.. Unless they get a K level drawn stat and resulted with each treatment and their bath adjusted with each treatment then they went some treatments without a change in their bath.

    Now people that's probably not the answer the OP wanted but it's the best answer... Again I believe this OP is looking to point fingers and that is MHO and as everyone know along with an a**ho*e we all have em..
    Sure.. if the patient was running on a K+2 instead of a K+3 for forty minutes, yes, their potassium wouldn't be getting what it needed to elevate it to the appropriate level... but still no major issue.. if they had not gone to dialysis that day, it wouldn't either, kwim? So it's not like a lifethreating issue. In hte mad chaos of turnover, this happens frequently.. not that it should, but it can and does happen.. usually several minutes into the tx. you notice the patient is on the wrong bath, still running on the previous patinet's bath.. and you put the machine in bypass and go fix it.. swith out the jug, and all is well.

    We do have checks and balances.. we always have another coworker come by and to do a dialyzer and acid check .. (it's like a double check)..but when the Sh*t is hitting the fan and their hands are tied, they don't always get there right when you're putting your patient on.

    I think we need to understand that this is NOT a perfect world, and dialysate nurses or other staff are NOT perfect human beings. Mistakes are sometimes made, just as in any other discipline, but these mistakes are not lifethreatening.

    We do our best with what we have. It does no good to nitpick and go hunting for things to get all excited over... until the day comes when the staff can focus on one patient at a time (LOL !!!!!!!!!! yeh, right) in dialysis, mistakes will continue to happen. The clincher is this... you are always aware of what the PRIORITIES are.. cognizant of those mistakes that CAN be fatal and on guard for those..

    Anything else is fixable.
  8. by   leslie :-D
    hi imperial,

    i am not a dialysis nurse but since one of my friends is a dialysis nurse and i am considering becoming one, i do read these posts.

    i can't put my finger on it yet you manage to offend and put sev'l of these respondents on the defense. i truly think a little self-reflection may be in order. you do come across as trying to gather info, but for purposes unknown which makes some quite suspicious.

    if the responses of distrust are consistent, which they are, then you need to reconsider finding other sources for your questions. these nurses that express their ire with you, are they all wrong? i think not. but your implications to these dialysis nurses are offensive, even when followed by "i know how busy you are"......just doesn't cut it.

    you need to treat these (and all) nurses with the respect they deserve. especially since you've never walked in their shoes, you nor anyone else should come across as so judgemental.

    i truly don't think it is your intent, but somehow you manage to antagonize too many of these dialysis professionals. please consider my constructive criticism so both sides will benefit.

    leslie
  9. by   ageless
    IMHO I think the questions asked by the original poster are sincere and completely acceptable. If the wish of Imperial is too educate his family and friends then that is a wonderful endeavor. Frankly, I do not see what the fuss is all about. I am confident in my abilities and knowledge base and only wish some of my patients would take this great of an interest instead of just wanting to know when their time on the machine is finished. I will gladly teach and
    I welcome your questions, Imperial, if only to erase some of the fears and misconceptions that are abundant in the hemodialysis patient community.
  10. by   RRN
    Quote from ageless
    IMHO I think the questions asked by the original poster are sincere and completely acceptable. If the wish of Imperial is too educate his family and friends then that is a wonderful endeavor. Frankly, I do not see what the fuss is all about. I am confident in my abilities and knowledge base and only wish some of my patients would take this great of an interest instead of just wanting to know when their time on the machine is finished. I will gladly teach and
    I welcome your questions, Imperial, if only to erase some of the fears and misconceptions that are abundant in the hemodialysis patient community.
    If HER only reason for all the questions were knowledge that would be fine. I wonder if you really read what SHE writes here????
  11. by   ageless
    yes, I have read the previous posts and again I do not feel offended or defensive. Imperials questions come from ignorance...ignorance is erased by answers.
  12. by   RRN
    Quote from ageless
    yes, I have read the previous posts and again I do not feel offended or defensive. Imperials questions come from ignorance...ignorance is erased by answers.

    No ignorance is erased by accepting knowledge..







    And saying I know people don't make mistakes intentionally means they do make mistakes..
  13. by   mommatrauma
    Quote from RRN
    No ignorance is erased by accepting knowledge..







    And saying I know people don't make mistakes intentionally means they do make mistakes..
    Are you implying that people are perfect then? Cause last time I checked, I'm not...and I'd venture a guess, you probably aren't either...so to imply that people make mistakes, I think is a reasonable implication. They do make mistakes...happens to the best of us...you asked why I didn't answer her questions?? I'm not a dialysis nurse, and to be honest with you, I've been a nurse for 10 years and all this dialysate questioning and answering...its like I'm trying to learn Japanese...so I offer you this, maybe its not that she is not listening and believing your responses, maybe its simply she still doesn't understand it...You are, I'm sure, well informed experienced nurse who was taught all about dialysis and dialysate to perform your job well...You probably know it inside and out...You are speaking to a person who has minimal exposure to or maybe not a great understanding of how the machines work and what the whole dialysis process is. It's like trying to explain to a non-medical professional the physiology of the heart using hospital jargon...just because you understand it doesn't mean everyone understands it the same way, or even at the same level. Also not everyone learns the same way...I am a visual learner...I like to see things done...put my hands on it...so someone can sit and lecture at me for hours and I may come out with only small amts of knowledge, put me in a physical situation, I learn much better and may come out with way more knowledge...Not everyone is created equal...and I think there is certainly no reason to answer with such hostility...regardless of how a question was asked...this site is for everyone to learn...I have learned alot from what people post on these forums, both positive and negative...I just hope your unpleasantness doesn't carry over into how you perform your job or how you interact with your co-workers that aren't sure of something...

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