Peritoneal Dialysis in the ED?

ERnursebyday · Mar 25, 2016

Heavens no!! I'm an ER nurse and have very little knowledge regarding dialysis. I would not feel comfortable completing this task.

Anna Flaxis, BSN, RN · Mar 25, 2016

Peritoneal dialysis isn't that difficult. People do it at home all the time. In fact, many of your PD patients can probably show you how to do it.

Do you happen to work in a small-ish community hospital with a nephrology clinic nearby? If that's the case, I'll bet you a nickel that your hospital has an agreement with them, and it's an important source of revenue that your hospital doesn't want to lose, as well as an important service that the patients in the community need and would not have available if not for your hospital's willingness to make this arrangement.

Is it the ideal situation? No, for a lot of different reasons that I don't need to elaborate on.

However, I think you'll have a lot more success trying to find ways to streamline the process so that you can move these patients through as efficiently as possible while still prioritizing your ED patients than you will by putting up a lot of resistance to it. If it's education you need, then request education.

sweetlilwolf · Mar 25, 2016

Nope! they had the nurses who do that usually come down and do it.

Lev, MSN, RN, NP · Mar 25, 2016

Our renal med surg nurses come down to the ED to do it.

Kitiger, RN · Mar 26, 2016

Peritoneal dialysis requires special training.

The risk of infection is huge, and infection is devastating. When done at home, great care is taken to keep all the connections sterile, or as close to sterile as is humanly possible. At least, in the home, the germs are familiar. Hospital germs are dangerous; they are new to the patient, and are quite possible drug-resistant.

Add to that the fact that your regular ER patients may require you to stop what you're doing with the peritoneal dialysis patient. This is a bad idea.

LadyFree28, BSN, LPN, RN · Mar 26, 2016

Peritoneal dialysis requires special training.
The risk of infection is huge, and infection is devastating. When done at home, great care is taken to keep all the connections sterile, or as close to sterile as is humanly possible. At least, in the home, the germs are familiar. Hospital germs are dangerous; they are new to the patient, and are quite possible drug-resistant.
Add to that the fact that your regular ER patients may require you to stop what you're doing with the peritoneal dialysis patient. This is a bad idea.

I had pts during clinical rotations undergo PD; it's done in the hospital and it's a sterile procedure to prevent infection; the same care at home is taken in the hospital; they can't skip getting PD in the hospital. :no:

Whenever we get a dialysis pt, a dialysis nurse is alerted and anything related to dialysis is performed by that nurse.

UnderRepair · Mar 26, 2016

I used to work in a renal ward and having been trained in PD, we would usually go down to ED (or CCU or other wards, wherever in the hospital the PD pt is) to do the PD. Or sometimes if the patients are well enough, they can do it themselves and we would just provide supplies. I don't think it's safe for others not trained to be doing the PD.

idialyze, BSN, RN · Apr 1, 2016

Hi,
I was wondering if any ED RN out there work in an ED that expects them to perform peritoneal dialysis in the ED? I work in an ED that is fairly busy, and patients who come in to the ED in need of PD frequently have it done in the ED. I think this is a bad practice. I have zero experience or knowledge of PD. I have been a nurse for 10 years, all in the ED, and have never worked any other place that required me to do this task. The consensus among our staff is that it is just another attempt to have patients wrapped nicely in a bow before going to a floor that simply doesn't do the work. I have tried to research with ENA and have found no reference to the procedure anyway. So I am wondering does any ER nurse out there think it is within there scope of practice or not. Also if you happen to know of links to any articles pro or con I would appreciate it as I am having a hard time finding any reference to PD being done in the ED. Thanks!

PD treatments are usually overnight for 7-9 hrs if they are on their cycler. It's seems to me the ED would want the patient out of there much sooner. Agree that's it a bad idea, too much risk of infection

for nurses that aren't trained. Hope this can be changed soon, for your sake. Yikes!

Dragonnurse1, ASN, RN · Apr 4, 2016

Any dialysis patient in our ER had a dialysis RN that was called in to take care of that patient. No ER nurses were tied up with this procedure.

floydnightingale · Oct 30, 2016

We don't touch that, and it's not that common at my ED. We see many hemodialysis patients daily, but I don't think I personally see as many as one peritoneal dialysis pt in a year's time. If I'm assigned one, I'll either gather what's needed from the dialysis floor and let the pt do it themselves, or a nurse from the floor will come down and do it.

offlabel · Oct 30, 2016

PD treatments are usually overnight for 7-9 hrs if they are on their cycler. It's seems to me the ED would want the patient out of there much sooner. Agree that's it a bad idea, too much risk of infection
for nurses that aren't trained. Hope this can be changed soon, for your sake. Yikes!

Must not be a very busy ER. Holy cow. But the procedure itself is not rocket science. Lay people with no formal training or knowledge in sterile technique\ microbiology do this in their living room on a long term basis.

If the ER nurses are able to be trained to take part in a full arrest scenario, they sure can do PD.