Toileting during Dialysis - page 3

by Lynx25

I am currently at a LTC facility, where several of our patients go out 3 times a week for outpatient dialysis. Currently, the facilty we send them to does NOT toilet our patients while they are there. They refuse to assist... Read More


  1. 3
    Quote from Ashley, PICU RN
    The simple reason is that they are there for dialysis. Nothing else. The nurses don't have orders from the MD to check blood sugar or administer insulin. Nor do they likely keep insulin at the dialysis facility. They are at the dialysis center for a specific purpose- dialysis. Like I said above, it's often not possible for the staff to leave the dialysis center/floor to transfer patients and in some cases the policy at their facility does not allow them to transfer patients. If the patient were to be injured or fall during transfer the facility would be liable. Or the nurse/tech were to be injured while transferring, their workman's comp would not cover it.
    That statement is VERY TRUE!

    I've worked in a dialysis facility for about 8 years and let me just say...if the patient is not ambulatory, then the patient MUST have an attendant with them during treatment for those simple things like bathroom assistance, and eating. Nurses CANNOT leave the floor while they are responsible for 5-8 other patients just for ONE patient to use the bathroom. Dialysis nurses are NOT responsible for insulin injections (and yes we do NOT have insulin at our facilities). Ignorant people, do the research on dialysis facilities BEFORE criticizing our line of work and our responsibilities as nurses and doctors. We cannot make ourselves liable for mishaps because we were treating conditions outside our vicinity.
    enchantmentdis, Lennonninja, and Natkat like this.
  2. 0
    There were also occasions where I was alone on the floor watching all the patients. Techs call out, water room needs tending to, lack of available staff, And guess how fun it is to code someone alone....... Not that fun. Luckily the emts and transportation people that brought the patients to and from dialysis were awesome. If they weren't so helpful. We never would have got by.
  3. 1
    Quote from PrettyLady87
    That statement is VERY TRUE!

    I've worked in a dialysis facility for about 8 years and let me just say...if the patient is not ambulatory, then the patient MUST have an attendant with them during treatment for those simple things like bathroom assistance, and eating. Nurses CANNOT leave the floor while they are responsible for 5-8 other patients just for ONE patient to use the bathroom. Dialysis nurses are NOT responsible for insulin injections (and yes we do NOT have insulin at our facilities). Ignorant people, do the research on dialysis facilities BEFORE criticizing our line of work and our responsibilities as nurses and doctors. We cannot make ourselves liable for mishaps because we were treating conditions outside our vicinity.
    Hmm, well, by calling us ignorant people for not doing research, I just find it ignorant that you can't take a person to the BATHROOM! Maybe you can help me understand why a nurse would not be able to take someone to the bathroom. If you are an RN, your job is to educate people. Try dong that before you criticize us for not knowing. It's people like you that scare all the new ones away. Geez.
    redhead_NURSE98! likes this.
  4. 1
    Again, dialysis equals doctor's office equals there is no staff to take pts to the bathroom.

    This is not a hospital, not LTC, it is outpt where pts are expected to be self-sufficient.

    Dialysis is not about keeping folks alive as long as possible, its about quality of life.

    If these pts are not cognizant, it is necessary to have a family conference about continuing dialysis. And...no this should not take any length of time. This is the nephrologist or mid-levels responsibility!
    just keep swimming likes this.
  5. 6
    Quote from lvn2bsoon
    Hmm, well, by calling us ignorant people for not doing research, I just find it ignorant that you can't take a person to the BATHROOM! Maybe you can help me understand why a nurse would not be able to take someone to the bathroom. If you are an RN, your job is to educate people. Try dong that before you criticize us for not knowing. It's people like you that scare all the new ones away. Geez.
    Many people on this thread have provided reasons why it is not always possible to toilet patients while on dialysis.

    But there is no need to call anyone ignorant, for any reason. None of us are deliberately providing poor care on purpose. There are flaws in the system- staffing, policies, patient rations, lack of supplies, etc. There's no reason to resort to name calling or insults. Please, let's all be professional.
  6. 3
    Quote from traumaRUs
    Again, dialysis equals doctor's office equals there is no staff to take pts to the bathroom.

    This is not a hospital, not LTC, it is outpt where pts are expected to be self-sufficient.

    Dialysis is not about keeping folks alive as long as possible, its about quality of life.

    If these pts are not cognizant, it is necessary to have a family conference about continuing dialysis. And...no this should not take any length of time. This is the nephrologist or mid-levels responsibility!
    I totally agree with this. I'm a SNF nurse but I can easily see the other side. Outpatient dialysis facilities are simply not set up to handle ADLs. They are outpatient offices. If we send Mr. Smith who is incontinent for a consult with his ortho we can't expect that someone there will feed him, check his blood sugar, give him insulin, and somehow hoyer him onto and off a toilet or change his brief. It's just not what they're set up for.

    At my facility we try our best to get a family member to accompany anyone who might need assistance while at dialysis. There is a certain criteria for sending a CNA with someone to an appointment and I don't think we've ever had anyone on dialysis who met that criteria. Most people we toilet/change right before they leave and as soon as they get back. We try to time those laxatives and stool softeners for the off days in an attempt to reduce the need to have a BM at dialysis. There have been a couple people who actually had a straight cath 3 x week prior to dialysis order.

    I'm not sure what the policy is at every dialysis center but at the Davita we work with most frequently they will allow the patient to have a small, non-messy snack if the pt can eat it themselves. There have been a couple people that take a "Nephro" supplement drink and a few that take a simple bagged lunch (sandwich, fruit) who had issues with their blood sugar dropping.

    I know there is a lot of resentment both ways but I have found when I talk to the dialysis nurses and try to understand where they are coming from they are willing to work with me to get issues resolved.
  7. 1
    Quote from lvn2bsoon
    Hmm, well, by calling us ignorant people for not doing research, I just find it ignorant that you can't take a person to the BATHROOM! Maybe you can help me understand why a nurse would not be able to take someone to the bathroom. If you are an RN, your job is to educate people. Try dong that before you criticize us for not knowing. It's people like you that scare all the new ones away. Geez.
    Have you not read the answers posted?
    enchantmentdis likes this.
  8. 1
    Quote from lvn2bsoon
    That is neglect, bordering on abuse. Good excuses for a dialysis clinic. Too bad that doesn't fly in LTC. I am surprised patients can't be assisted to the bathroom and helped. What do you tell them if they say they need to go? "No, I can't take you, sorry?" Hmmm. Nice.
    Neglect would be leaving all the other patients unattended and in an unsafe situation to take one person to the restroom. Don't even get me started on all the neglectful things I could write up on what I see in the patients who come from LTC. The bottom line is this, we cannot take patients to the restroom. We have no one to assist them, nothing to clean them with, and nothing to change them into. They do not get left to sit in it they get sent back to their facility. The families and LTC are fully aware that they are supposed to send an attendant with the patient in order for them to be accepted into our outpatient clinic. It is neglectful for them to not follow through with their agreement. please toilet and feed the patients before sending them to dialysis. Otherwise they suffer by having their treatment cut.
    Natkat likes this.
  9. 0
    Quote from MJB2010
    Have you not read the answers posted?
    Yes, I have. I was replying to another post. I got it now. I don't work in dialysis, and I probably never will. LTC was enough for me. I get it. I don't, and I don't think others, appreciate being called ignorant. That was my original reasoning behind this reply. I was not the original poster calling others ignorant.
  10. 0
    Quote from missladyrn
    Neglect would be leaving all the other patients unattended and in an unsafe situation to take one person to the restroom. Don't even get me started on all the neglectful things I could write up on what I see in the patients who come from LTC. The bottom line is this, we cannot take patients to the restroom. We have no one to assist them, nothing to clean them with, and nothing to change them into. They do not get left to sit in it they get sent back to their facility. The families and LTC are fully aware that they are supposed to send an attendant with the patient in order for them to be accepted into our outpatient clinic. It is neglectful for them to not follow through with their agreement. please toilet and feed the patients before sending them to dialysis. Otherwise they suffer by having their treatment cut.
    I know what you mean about LTC, I spent many years there. Our dialysis procedures were a little different, as we didn't send an attendant with them.


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