Question about patients receiving dialysis

Specialties Geriatric

Published

Specializes in NICU, Pediatric Urgent Care.

Is it your nursing home's policy for the nurse to assess the patients catheter site to make sure its free of infection when making their start of shift assessments? Specifically a patient that receives dialysis at a dialysis center three x's a week?

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Specializes in NICU, Pediatric Urgent Care.

Ok no answers... Let me reword it. Do you, as nurses, assess a patient's dialysis catheter site on your start of shift assessment?

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Specializes in Professional Development Specialist.

I don't have any patients with dialysis catheter sites, just one with a PD site. I assess that, just as I would assess an IV site that isn't being used by us. I don't know the written policy but I would think policy would be yes, since we are to assess every bruise and scratch on our pts every shift.

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Specializes in LTC/Rehab.

I, personally, feel it's a nurses responsibility to assess any appliance q shift, whether it be an IV, AV shunt/fistula, port, etc., regardless of whether or not you yourself are going to administer meds/flush/dialyze with said appliance. In the case of a dialysis patient, a port should be monitored q shift for s/s of infection. You should monitor for cleanliness to the area, and of course, in the world of LTC there's always the possibility of displacement so you should monitor q shift for proper placement. AV fistula's should be monitored q shift for the bruit/thrill.

Our facility requires documentation q shift for dialysis patients, and even if it wasn't our policy I would still monitor the appliance q shift.

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Is it your nursing home's policy for the nurse to assess the patients catheter site to make sure its free of infection when making their start of shift assessments? Specifically a patient that receives dialysis at a dialysis center three x's a week?

Yes, absolutely. Any dialysis patient has an order to assess the site q shift and document findings.

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Specializes in home health, dialysis, others.

If there is an intact dressing over a catheter, then that is all you need to assess. DO NOT remove, adjust, peek under, or otherwise disturb a dialysis catheter. Unless you have an order, most dialysis units really do not want anyone to touch the dressings.

As for fistulas and grafts, by all means please assess for thrills and bruits very gently. Sometiems there is only a faint thrill, but there should always be a good bruit. Remember, no BP or blood draw on the shunt side, and if they have a cath, check to see if there may be a tentative site for shunt placement.

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Specializes in Nephrology, Cardiology, ER, ICU.

You should NOT be checking for positioning of a permcath either: ensure the dr4essing is clean, intact but do not otherwise mess with it. If it should become dislodged, just tape it up and contact the dialysis unit ASAP..

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Hi,

We do have an order to assess cath site q shift for signs of infection.

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Specializes in Nephrology, Cardiology, ER, ICU.

Are you removing the dressing?

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Specializes in Hem/Onc, LTC, AL, Homecare, Mgmt, Psych.

Yes, nursing does check the catheter to make sure it is intact in our SNF. Not removing any dressings just visual inspection. Q Shift. If the pt has a fistula we do listen for bruit and feel for thrill as well. Any abnormals we update the dialysis clinic or MD. Also when the pt comes back from dialysis we obtain a full set of vitals. We've had too many dialysis pts crash when they come back (low BP).

Is it your nursing home's policy for the nurse to assess the patients catheter site to make sure its free of infection when making their start of shift assessments? Specifically a patient that receives dialysis at a dialysis center three x's a week?
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Specializes in jack of all trades.

It's perfectly to check the site but never never remove the dressing! Dont utilize it for any type infusions even if you cant get an individual like else where never use that line. It's the pt's lifeline and dialysis nurses can and will be very protective of those lines. You shouldnt be doing dressing changes etc either. All it needs is dressing dry/intact. No obvious signs of bleeding or other complications. Also ensure the caps are on. I have had them come to the dialysis unit with no caps on when I knew I put caps on before they left from thier last treatment before.

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Specializes in NICU, Pediatric Urgent Care.

So if you never remove the dressing or look under it then how do you tell if the site's getting/becoming infected?

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