Hemodialysis in CC or in Dialysis unit?

[KimRN66]

I am doing some reseach for a nephrologist and would like some input. I am looking for someone who works for a hospital in which there is a policy written that says whether a patient in critical care has their hemodialysis done in the dialysis unit or at bedside? Where I presently work there is not a specific written policy, it is just an understood policy based on mainly the patients acuity. Our nephrologist is looking specifically for a hospital that has a policy so that we can compare to our practice. If anyone has any info re: this I would appreciate this help. Thanks

Kim Walker, RN, BSN, CNN

[vortex72]

I helped write a policy for the last company I was employed with.

Renal Care group.

Basically we had simple guidelines as follows:

ICU patients are normally dialyzed at bedside whenever possible. However due to equipment and staffing constraints we developed policy regarding when ICU patients could be treated in acute dialysis clinic.

ICU patients could be dialyzed in acute clinic instead of bedside under these conditions:

not on mechanical ventilation

hemodynamically stable (insert parameters here)

o2 sat stable and not requiring anything more agressive than facemask for 02 sat support

not in isolation

Not on any titrated drips (set rate ok)

patient can NOT be admitted straight from ER to dialysis unit if the patient is waiting on an ICU bed unless the pt meets above guidelines

these were our basic guidelines. I have extensive ICU experience so managing an ICU patient is no big deal. However, you run into problems with legalities and responsibilities when you have RN's from a dialysis company taking on ICU responsibilities outside the ICU unit. We also had some friction a few times when a really sick pt in the ER needed stat dialysis but no ICU beds were available(we dont dialyze in ER) In that case the hospital had to send and ER or ICU nurse to stay with patient in dialysis unit.