What should EVERY nurse know about Dialysis - page 3

by Twink

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I am a dialysis nurse turned home care nurse...live in a rural area that recently has had a dialysis center open (I work there PRN). With this opening the local home care agency has seen an influx of dialysis patients...and due... Read More


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    There was a patient in a clinic I worked at who was on a 1K bath for at least 3 years, she is probably still on it today. Her K was normally over 6 with labs. Under 6 was a miracle! Dietary education from everyone was no use.
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    The best time to eat is not while on the dialysis machine. Some of pt's blood is in the bloodlines, while eating, a lot of blood goes to digestive system. That leaves brain and heart short of blood, then blood pressures drop to dangerous levels.
    jb2u and traumaRUs like this.
  3. 0
    Eating during the dialysis treatment causes sphlanic effect thus the patient's blood pressure dramatically drops.
    Sometimes, if the blood pressure is okey or above the normal range, we allow the patient to eat during dialysis session. We just monitor the patient's blood pressure regularly.
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    I wish doctors understood this, too!! We wanted to make it so that they couldn't eat while on dialysis, but we can't get the patients or the doctors to go along with it. We do not allow patients with low bp's or new starts to eat, but in general everyone else eats.

    A lot of floor nurses think we are just being mean or lazy. I actually had the opportunity to "show" some of them the fluid shift while eating by showing them the critline machine while the patient is eating. It is something. You can see the blood volume drop and after they stop eating it goes back up!!!
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    How important pt compliance is with diet, fluid restriction, and taking their meds as directed.
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    before cannulating the access of the patient let them wash it first with soap (fistula.graft), then always check for thrill and bruit. Absence of those 2 means the access is no longer patent.Then the distance from the fistula to the bevel of arterial needle is 2.5", then arterial to venous 3" is Ok. Always observe the distance to avoid recirculation of blood and for the longevity of the access....and always rotate your insertion site to prevent aneursym...
    nurse671 likes this.
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    Quote from sissib
    How important pt compliance is with diet, fluid restriction, and taking their meds as directed.
    - before advising the pt. to have eat all you can scenario maybe you should assess the pt. first if he can manage,because the pt. may experience hypotension while the Hd is ongoing.Maybe small frequent feeding may do to avoid that,..Fluid restriction is very impt., for ESRD pts. 500ml/day is advisable to prevent fluid excess.More than that may cause edema,ascitis,dyspnea, chest pain etc.
  8. 1
    Quote from julzrncrn
    - before advising the pt. to have eat all you can scenario maybe you should assess the pt. first if he can manage,because the pt. may experience hypotension while the Hd is ongoing.Maybe small frequent feeding may do to avoid that,..Fluid restriction is very impt., for ESRD pts. 500ml/day is advisable to prevent fluid excess.More than that may cause edema,ascitis,dyspnea, chest pain etc.
    Did you mean to write 500ml/day plus their volume output?
    I have been doing dialysis for over 20 years and never had a pt on a 500ml/day fluid restriction. They are generally on 1000 - 1500ml/per day.
    500ml of fluid is lost each day in their bodies through their lungs and skin alone

    The other thing to think about is infection control in a clinic is another reason for not eating....I do not allow any eating in the unit - I had to get my medical director to sign off on this policy and it was posted all over so the patients could see it
    tickledpink likes this.
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    The most dangerous day for a dialysis patient is Mondays. More dialysis patients code on Monday than any other day of the week. 2 days is a long time to go without dialysis. The most dangerous time for a dialysis patient is the first two hours after a treatment, after they have returned to the floor or left the clinic. Large changes in electrolytes are occuring between the blood and tissue as these chemicals equilibrate after the dialysis treatment is completed.
    hemanth likes this.
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    Pt.'s should also not eat on the machine for infection control issues. Blood+Food+Sharing food with neighbor=NASTY!
    traumaRUs likes this.


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