[nursedandy]

In your facility,what do you do when patient experience chills during HD treatment?

[Sweetooth EMT-P, RN]

Give them a blanket...maybe ??

[traumaRUs]

First, take their temperature. ESRD pts on HD can become septic VERY quickly. Then...if they do have a temp, obtain blood cultures x2 and treat for Vanco (for gram positive cocci) and tobra (for gram negative).

[DeLana_RN]

Agree with pp, chills usually indicate an infection (often, the perm cath is the source). Call the MD, who will usually order blood cultures and antibx.

Of course, make sure the A/C isn't on deep freeze, but this is usually not the cause of intradialytic chills.

DeLana

[augigi]

Originally Posted by traumaRUs

First, take their temperature. ESRD pts on HD can become septic VERY quickly. Then...if they do have a temp, obtain blood cultures x2 and treat for Vanco (for gram positive cocci) and tobra (for gram negative).

Call the doctor, don't treat with anything.

[traumaRUs]

Augigi - in dialysis - RN's operate on protocols. It can be perfectly acceptable to do this from protocol. Please also understand as my signature indicates, I am an advanced practice RN and have no need to call the doctor for this scenario.

[DeLana_RN]

I should have added to my reply (and almost did) that many clinics have standing orders or protocols for such a scenario; in this case, you might still call the doc as a courtesy, or mention it if s/he rounds.

DeLana

[augigi]

Originally Posted by traumaRUs

Augigi - in dialysis - RN's operate on protocols. It can be perfectly acceptable to do this from protocol. Please also understand as my signature indicates, I am an advanced practice RN and have no need to call the doctor for this scenario.

I know you are, but I don't think that's a "nursing intervention", so much as an advanced nursing intervention. IN addition, I don't know if the OP is an APN.

I've never seen a protocol which permits a non-APN to initiate something like vancomycin.

[traumaRUs]

Maybe you need to not tread where you know not? Seriously, our nephrology practice is protocol-driven and this is well within the scope of practice in IL.

[augigi]

I'm not trying to tell you that you're not correct. I'm not sure how you would presume to know my level of knowledge in anything, apart from the fact that I am not in the US...?

I merely was pointing out to the OP that they may not be able to do this, since it's not apparent they are either an APN or in your state.