Toileting during Dialysis - page 4

by Lynx25 11,122 Views | 36 Comments

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


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    We are seeing more NH getting into outpt dialysis too - this solves the problem of LTC pts having to be toileted at a dialysis clinic.
    Kooky Korky and VivaLasViejas like this.
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    Quote from traumaRUs

    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!
    While I agree with you about this, it does not always happen this way. There are many things that are the nephrologist or mid-levels responsibility that are initiated by nurses or social workers because the others do not do it. I am not suggesting that you do not; and when I am an NP, I will make sure that I initiate care conferences when necessary. Unfortunately, this has not been my experience so far.

    What I was saying takes time is getting all involved parties together and then getting them to actually make a decision. I make it a point to be a part of these meetings for all of my patients and there is always so much fighting within the family that we are never able to come to an agreement immediately. There have been times when we have had to take it to the ethics commitee at the hospital and that does take time.

    But back to the issue at hand...Trauma is right. Even though I do make it a point to toilet patients and make sure they are cleaned up, this is not our responsibility and we are not equipped to do it. I have a very senior staff who is able to manage time very well and they work as a team. I know this is not so in other units and that it would be impossible to take care of patients in this way at those clinics.

    People forget that we are an outpatient clinc because we see our patients so regularly and oftentimes go above and beyond for them. We have to draw the line somewhere. My advice to LTC nurses is to establish an open line of communication with your patients dialysis nurses and coordinate their care. This goes for toileting as well as meds, meals, post HD problems, etc. You would be amazed how far a little communication can go.
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    I'm a LTC nurse, and I don't blame the dialysis staff for not toileting the patients. They have neither the staff nor the supplies. Of course, expecting us to send a CNA is equally absurd.
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    Quote from BrandonLPN
    I'm a LTC nurse, and I don't blame the dialysis staff for not toileting the patients. They have neither the staff nor the supplies. Of course, expecting us to send a CNA is equally absurd.
    I agree, however, the ltc agrees to these terms as does the family when trying to get a spot in our clinic. I have yet to see one follow through with it. But it is part of he agreement. We do however have 2 patients who are capable of toileting themselves that bring their private care nurse with them to treatment at least once a week. They just play cards with the patient and such.
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    I am upset by reading what it is like at so many dialysis centers. I am upset to read nurses bickering back and forth and blaming each other for ignorance and lack of awareness.

    I hope those who work in LTC and dialysis will begin to develop better communication in order to help the patients.

    Remind me, though, to never go on dialysis unless I can do it myself at home. Even then...
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    Quote from Kooky Korky
    I am upset by reading what it is like at so many dialysis centers. I am upset to read nurses bickering back and forth and blaming each other for ignorance and lack of awareness.

    I hope those who work in LTC and dialysis will begin to develop better communication in order to help the patients.

    Remind me, though, to never go on dialysis unless I can do it myself at home. Even then...
    We do toilet our pts if they need to go and i have done incontinent care more times than i can count.... ive even changed a foley cath in dialysis....
    That being said we do try to discourage use of the bathroom while they are dialyzing
    just keep swimming likes this.
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    Quote from MJB2010
    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.
    Um yea...that's not legal at all lol.

    And you have the right to hold a tech from break to legally avoid being by yourself if a code happens. Too dangerous!


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