What should EVERY nurse know about Dialysis

Specialties Urology

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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 to conflicts of interest I can not be their primary home care nurse. I am planning an in-service focusing on basic need to know info on dialysis patients and care needs. So I ask you, the dialysis nurse....what do YOU wish EVERY nurse knew about the dialysis patient?

Specializes in Med/Surg, Rehab, Burn, dialys.

How important pt compliance is with diet, fluid restriction, and taking their meds as directed.

Specializes in DIALYSIS.

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...:cool:

Specializes in DIALYSIS.
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.
Specializes in Dialysis (acute & chronic).
- 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 :jester:

Specializes in Dialysis.

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.

Specializes in Dialysis.

Pt.'s should also not eat on the machine for infection control issues. Blood+Food+Sharing food with neighbor=NASTY!

Specializes in Nephrology.
This is not sound medical practice. Pts should adhere to a low K+ diet because if there are unforeseen events and they miss dialysis, they can and do die of hyperkalemia.

I know of no nephrologist or mid-level worth their salt who would advocate a 1k bath just because a pt wants to consume high-K+ food.

You are just asking for a lawsuit.

Yikes! What if they decided not to eat that extra bannana? Can anyone say code????

Specializes in Nephrology.

1. Check that access every day! If it is clotted, the chances of saving the access are much better when caught early. They need to check for bruit and thrill each day

2. Reinforce fluid and dietary restrictions. The more we tell them, the more hope there is of them understanding. Sometimes its better to hear it from someone other than the nagging dialysis nurse! lol

3. Encourage them to come to all treatments. I can't tell you how many times a nurse has called from a nursing home or a HHN has called to tell me the patient just doesn't feel like coming. Yes it is their choice, but educate and encourage! It's not okay to skip because you don't feel well, you probably don't feel well because you need dialysis!

4. Take medications as prescribed and at the time prescribed. Some medications need to be taken after HD so that they do not dialyze off. Some meds work better when taken at different times of the day, like sensipar.

5. Incidence of stroke and heart attacks increase greatly in the hour or two post dialysis. Monitor patients closely.

6. Education or reeducation on symptoms of different electrolyte imbalances

7. If your patient is going to a dental appointment, they need abx before hand. If you don't have an order, call me and I will call it in for them.

8. Do not get CVC's wet, and if you do, don't leave that wet dressing sitting on there. I know you aren't supposed to touch it, but really, where does bacteria thrive? Under a clean, dry dressing? I think not!

9. Same goes for the dressings on AVF and AVG. If it's wet, take it off.

10. Do not leave those dressings on until the next treatment, you are risking clotting off their lifeline!

11. If an access starts bleeding, don't panic. Apply pressure and wait. If bleeding does not stop they may need a stitch

12. NEVER be afraid to call the unit and ask about something! It makes our job easier if you call with questions instead of letting something go or doing what you would do for anyone else.

Hope this helps!

Many dialysis patients have psych/emotional issues. So you have a schizophrenic in a chair for 3-4 hours. Or someone who winds up crying towards the end of every treatment, three times a week. The nurse to patient ratio is 1:9, 1:10, or worse, depending on your state's laws. If you're used to an ER or LTC, this will be easy for you. If not, it is A LOT to handle at once.

Specializes in Dialysis, Facility Administrator.

I would tell the would-be dialysis nurse that you have to have thick skin. Especially in a chronic unit, you'll feel like a hampster in a wheel....running as fast as you can, but never reallly getting anywhere. There will be days you will drive home sobbing from frustration with techs, patients, your administrator. There will also be days you know you've made a difference in someone's life, especially when they get transplanted and come back to thank you personally for everything you've ever done for them and that they'll never forget you.

I'd also tell them it's the most rewarding job I've ever had, and I'll be in dialysis until I retire (though I may explore different modalities at some point).

I would tell the would-be dialysis nurse that you have to have thick skin. Especially in a chronic unit, you'll feel like a hampster in a wheel....running as fast as you can, but never reallly getting anywhere. There will be days you will drive home sobbing from frustration with techs, patients, your administrator. There will also be days you know you've made a difference in someone's life, especially when they get transplanted and come back to thank you personally for everything you've ever done for them and that they'll never forget you.

I'd also tell them it's the most rewarding job I've ever had, and I'll be in dialysis until I retire (though I may explore different modalities at some point).

Do u know where i can train to be a dialysis tech

Specializes in Dialysis, Facility Administrator.
Do u know where i can train to be a dialysis tech

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