To all my dialysis peers...I work in a rai/fresinius clinic in sc. I have worked in the clinic for 8 months. Each patient as you know has a special bath...2k2.0 or 2k2.5...which we pull from the machine. However we have over 90 patients with 30 or so being on special baths like 3k2 and 3k2,5 and 2k3. Recently my supervisor said we can no longer mix baths Bc there might be more potassium in one or calcium in the other...I'm taking about putting 2 half jugs of 3k2.0 into one for another patient. So now each day each rn is making up to 10 new baths which is quite time consuming and labor intensive. My thought is all the jugs when filled are filled to the same level with the same mix so when you combine them the concentration should be the same. However our biomes guy who knows everything brought it to my supervisors attention it's not. I'm asking how to other clinics deal with this? Does anyone know what dhec says? Or kidney councils? And information for or against this practice? I work sometimes 14 hiur days and the last thing I want to do is make 10 new baths after a long shift....thanks for any help!!!
Jul 2, '12
This makes no sense. A bath should have the same concentrate from top to bottom, so mixing 2 jugs of the same concentrates shouldn't change things. Ask to have them checked by sending some samples to the lab - 1 from Jug A, 1 from Jug B and 1 from jug A/B. They should be the same.
We did this for years. Of course, I did dialysis in the olden days, and I also mixed baths by hand!
I worked with SorbSystem equipment that was all mixed by hand, as well!
Ask for proof. Ask to see some documentation.
Jul 5, '12
Just ask your boss to order some 3K jugs. I assume you are talking about gallon jugs. It's probably cheaper anyways.
Jul 19, '12
You may need to consult with the medical director and just make your bath's more streamline. Like all our 2k baths are 2.5ca point blank. I think if the medical director is made aware that this will lessen the likelyhood of a medication/prescription error he/she may be more willing to streamline thier orders.
Jul 23, '12
In our clinics we cannot mix the left over bath due to infection control. Once a supply has been utilized on one patient it cannot be utilized on another. So we dump the left over jugs. We centrally pump in 2K, so our only mixing is for maybe 10% of the patients. I will look through the guidelines to see if there is an exact line on this.
Jul 23, '12
Found it faster than I thought. From the CMS ESRD Program Interpretive Guideline V116 "Items taken into the dialysis station should either be disposed of, dedicated for use only on a single patient, or cleaned and disinfected before taken to a common clean area or used on another patient. Nondisposable items that cannot be cleaned and disenfected (e.g. adhesive tape, cloth covered blood pressure cuffs) should be dedicated for use only on a single patient. Unused medications (including multiple dose vials conatining diluents) or supplies (syringes, alcohol swabs, etc.) taken to a patient's station should be used only for that patient and should not be returned to a common clean area or used on other patiens."
Since there is no way to disenfect the bath, our interperation was that the jugs must be disposed of for each patient.
Jul 23, '12
I support the interpretation of the ESRD Conditions - however, not sure a surveyor would see the same -- In fact, you can contact the state and ask them the question and they can tell you - if you can speak with a surveyor who is dialysis expertised -
Second, it is far better to have each patient's bath individualized - in my opinion -- for some patients, they do better on a 2K which allows them to eat more K foods, others might require a 4k or 1k --- I think this method of mixing is dangerous and remember you have a license to protect if something goes wrong ---
And, I would want to see a '''policy/procedure''' that supports what you are doing with the baths -- I would not just do what I am told without seeing a policy to cover my buttocks ---- simply put...........
there have been too many cases where a nurse has gotten the brunt of something because she/he was told to do something and there was NOT a policy/procedure in place -
just my thoughts
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