Nursing intervention?

  1. In your facility,what do you do when patient experience chills during HD treatment?
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  2. 13 Comments

  3. by   AnnieOaklyRN
    Give them a blanket...maybe ??
  4. by   traumaRUs
    First, take their temperature. ESRD pts on HD can become septic VERY quickly. Then...if they do have a temp, obtain blood cultures x2 and treat for Vanco (for gram positive cocci) and tobra (for gram negative).
  5. by   DeLana_RN
    Agree with pp, chills usually indicate an infection (often, the perm cath is the source). Call the MD, who will usually order blood cultures and antibx.

    Of course, make sure the A/C isn't on deep freeze, but this is usually not the cause of intradialytic chills.

    DeLana
  6. by   augigi
    Quote from traumaRUs
    First, take their temperature. ESRD pts on HD can become septic VERY quickly. Then...if they do have a temp, obtain blood cultures x2 and treat for Vanco (for gram positive cocci) and tobra (for gram negative).
    Call the doctor, don't treat with anything.
  7. by   traumaRUs
    Augigi - in dialysis - RN's operate on protocols. It can be perfectly acceptable to do this from protocol. Please also understand as my signature indicates, I am an advanced practice RN and have no need to call the doctor for this scenario.
  8. by   DeLana_RN
    I should have added to my reply (and almost did) that many clinics have standing orders or protocols for such a scenario; in this case, you might still call the doc as a courtesy, or mention it if s/he rounds.

    DeLana
  9. by   augigi
    Quote from traumaRUs
    Augigi - in dialysis - RN's operate on protocols. It can be perfectly acceptable to do this from protocol. Please also understand as my signature indicates, I am an advanced practice RN and have no need to call the doctor for this scenario.
    I know you are, but I don't think that's a "nursing intervention", so much as an advanced nursing intervention. IN addition, I don't know if the OP is an APN.

    I've never seen a protocol which permits a non-APN to initiate something like vancomycin.
  10. by   traumaRUs
    Maybe you need to not tread where you know not? Seriously, our nephrology practice is protocol-driven and this is well within the scope of practice in IL.
  11. by   augigi
    I'm not trying to tell you that you're not correct. I'm not sure how you would presume to know my level of knowledge in anything, apart from the fact that I am not in the US...?

    I merely was pointing out to the OP that they may not be able to do this, since it's not apparent they are either an APN or in your state.
  12. by   traumaRUs
    No problem - Just as I would not presume to know what is done in Australia, you certainly must realize that different countries do things differently. In the US overall, much of dialysis care is protocol-driven. I work in two dialysis units owned by a large for-profit company. They do protocol-driven care and this is common practice. These protocols are enacted by the staff RN's.

    If you preface your comments with "in my experience" than that lets people know that there are many kinds of experience and your comments are based solely on your own experience.
  13. by   augigi
    Since the question said "in your facility what would you do" I presumed that is what was being asked. Point taken.
  14. by   DeLana_RN
    Quote from augigi
    I've never seen a protocol which permits a non-APN to initiate something like vancomycin.
    I'm an RN who worked in an outpatient dialysis clinic for 5+ years; our standing orders/protocols included giving Vancomycin 1 gram for up to 3 doses while culture results were pending for presumed catheter infections as evidenced by purulent drainage at the exit site; this protocol was of course approved by our nephrologists, but was suggested by RNs and RN managers. (Note that culture results were to be called to the MD as soon as available.)

    The protocol was very specific; in the case of suspected infection (redness at the exit site, but no drainage) we were not allowed to initiate Vancomycin unless the MD was called and approved it based on VS and other assessment data.

    DeLana

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