Latest Likes For madwife2002

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madwife2002, BSN, RN (92,026 Views) Senior Moderator

Joined Jan 17, '05 - from 'Ohio'. madwife2002 is a Clinical Service Specialist. She has '26' year(s) of experience and specializes in 'RN, BSN, CHDN'. Posts: 10,259 (21% Liked) Likes: 6,066

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  • Jan 22

    QUOTE=jdub6;8720120]Oh good, renal/dialysis is my weak spot for sure. I have tons of questions...trying to think of what I need to know the most...
    1. Can you describe the dialysis procedure, what you do when the patient arrives (assume outpatient unless you don't know about that) until you send them off

    This is a huge question, one that takes about 6 hours from start to finish-When a patient comes to treatment you would do vital signs, the RN would do head to toe assessment looking for signs of fluid overload, they would be weighed and the target amount of fluid calculated. Arm if fistula is used would be cleaned and needles inserted, pt’s prescription would be dialed into the dialysis machine and then the lines would be connected and dialysis commenced. Pt should be monitored every 30 mins vital signs taken, access site visualized at all times. Once tx has finished the patient is disconnected from machine, needles are pulled, access is held until hemostasis occurs, then the sites are covered with either a bandaid or gauze. Pts vital signs and weight is taken and pt is discharged home.

    2. What is ultrafiltration and why/for whom is it used?
    Ultrafiltration is defined as controlled fluid removal by manipulation of hydrostatic pressure. Ultrafiltration in dialysis is the removal of sodium and water from the blood. Dialysis patients have ultrafiltration; some of the patients need more fluid removal than other patients.

    3. How do you access an AVF? What type of needle do you need? Is there a difference between the venous and arterial access equipment? Are the venous/arterial access points all in the same place each time and if so what landmarks do you use? What are things that would be indications of problems, reasons not to use a fistula or to stop using it, etc.? What would you see in a fistula that is clotted? Any considerations for the first time you use a new fistula?

    You access an AVF with fistula needles; there are different size needles used on average a 15 gauge needle is used. Needles have blue and red wings for venous and arterial identification. Where you place the needles depend on what method of cannulation is being used. Each treatment the AVF should be examined looking for signs of infection, feeling the AVF for thrill and listened to the AVF for the bruit. If there is no thrill or bruit the fistula should not be accessed as absence of these could indicate the fistula is clotted. Lots of considerations for first use of fistula-experience technician, one needle, size 17 gauge needle, lower blood flow rate.

    4. What do you dialysis nurses consider to be the best/easiest form of access to use (which type of catheter, fistula, etc) and which type or protocol of dialysis is best and easiest for you and the pt?

    The best access without question is the Fistula. I don’t understand what you mean about protocol

    5. When people refer to arterial and venous ports/needles for dialysis, and when we see what I think of as a typical dialysis cath with two lumens, usually one red cap and one blue, are those lumens or (or needles for a fistula) actually one in a vein and one in an artery? My impression is that fistulas are mixed arterial/venous blood. Honestly, I don't know exactly where the catheters end. Do the red and blue caps indicate arterial and venous, as in other parts of medicine? And, again, does the arterial port/line actually end in an artery, or a vein?

    Catheters end in the heart. Red and Blue in dialysis indicate venous and arterial


    6. Can you explain how you use the catheters i.e. do you flush them prior to access and if so with what, which port do the inbound and outbound/return lines go to? After use, how do you flush the lines?

    There is a whole process for using catheters, and accessing catheters. Many steps are involved, what in particular do you want to know about accessing them although it may differ from company to company. In bound and outbound lines are really called venous and arterial lines. The venous side of the catheter attaches to the venous line and the arterial-to-arterial line. The arterial line takes the blood out of the body to the dialyzer (kidney) and the venous line returns the cleaner blood to the body. After use you flush the lines with Normal Saline

  • Jan 10

    People change their minds at the last min sometimes, a tattoo would be so permanent that would be my only concern,.

    I have always said I do not want interventions if there is no hope for some incurable disease, but if it was an accident then I would at least want them to try.

  • Jan 10

    People change their minds at the last min sometimes, a tattoo would be so permanent that would be my only concern,.

    I have always said I do not want interventions if there is no hope for some incurable disease, but if it was an accident then I would at least want them to try.

  • Jan 10

    People change their minds at the last min sometimes, a tattoo would be so permanent that would be my only concern,.

    I have always said I do not want interventions if there is no hope for some incurable disease, but if it was an accident then I would at least want them to try.

  • Dec 26 '15

    Yes I have and it is very frightening, and they always seem to get away with it
    One nurses springs to mind here are a few examples

    She lay the pt flat on his back when the pt was chocking and had no clue what to do
    She infused a PEG feed stat to a new insertion because she said nobody had ever shown her how to use the machine-we only found out because the pt was projectile vomiting
    She used a hoist to bath a pt who had locked in syndrome, didnt know how to use the hoist and dropped him in the bath he almost drowned
    She cried hysterically in pts rooms
    She gave insulin to a pt who didnt need it at 4am
    We had a file on her inches thick but in the UK you cant just fire a nurse you have to comply a list of complaints, investigate provide education and help improve said RN and then complain to the board of nursing-which can take years

  • Dec 24 '15

    You know you are in trouble when the ETOH pt is on day 2 of his hospital admission

    You know you are in trouble when the pt asks for dilaudid for headache because nothing else works

  • Dec 24 '15

    America's middle-class workers - defined as those families earning between $45,000 and $85,000 - are among the hardest hit when it comes to rising health-insurance costs, a new report indicates.


    Released today, the analysis was conducted by the nonpartisan Robert Wood Johnson Foundation. It suggests that the number of uninsured middle-income Arizonans jumped by nearly 27 percent between 2000 and 2008.

    http://www.azcentral.com/business/ar...sured0317.html


    Thought I would share this with the sceptics who still believe it is possible to ignore the growing need for health care reform

  • Dec 7 '15

    Induction defiantly increases the risk of complications.
    Although ultrasound is a tool by what we measure dates it is an approximate or estimate date of delivery. A date given to a pregnant woman is not a date set in stone.
    Women go into a normal labor anywhere from 38-42 weeks which is a huge window.
    I believe unless there are complications and we need to get the baby out, we should leave women alone to go naturally into labor with minimum interventions.

    Of course a lot of woman I looked after when I was a midwife want to be induced because they are sick of being pregnant especially those last few weeks when they are so uncomfortable.

    In the UK if I remember correctly being induced increased the chances of a C section by over 35%

  • Dec 6 '15

    Quote from nursel56
    But what if I want to misspell stuff on porpoise?
    Dont fink I shud offr to be the mod do u?

  • Nov 25 '15

    It is really frightening isn't it! I remember getting a needle stick injury and I just went cold-It is a kind of shock that you cannot believe it has just happened.
    Dont be dissapointed in yourself it was an accident and sometimes I am surprised it doesnt happen more often.

    (((((((((((((((((((((((((((((HUGS))))))))))))))))) )))))))))))))))))))

  • Nov 19 '15

    It happened to me once many years ago, I so totally understand the feeling-The patients wife gave me a folded bill I tried reasoning but they were so instant when I looked it was $100 and I never felt so awful and horrible in all my life
    I left the money in a drawer in my house for a long time and then I too donated it

    I will never ever allow anybody to give me money again

  • Nov 17 '15

    It happened to me once many years ago, I so totally understand the feeling-The patients wife gave me a folded bill I tried reasoning but they were so instant when I looked it was $100 and I never felt so awful and horrible in all my life
    I left the money in a drawer in my house for a long time and then I too donated it

    I will never ever allow anybody to give me money again

  • Nov 17 '15

    It happened to me once many years ago, I so totally understand the feeling-The patients wife gave me a folded bill I tried reasoning but they were so instant when I looked it was $100 and I never felt so awful and horrible in all my life
    I left the money in a drawer in my house for a long time and then I too donated it

    I will never ever allow anybody to give me money again

  • Nov 17 '15

    It happened to me once many years ago, I so totally understand the feeling-The patients wife gave me a folded bill I tried reasoning but they were so instant when I looked it was $100 and I never felt so awful and horrible in all my life
    I left the money in a drawer in my house for a long time and then I too donated it

    I will never ever allow anybody to give me money again

  • Nov 17 '15

    It happened to me once many years ago, I so totally understand the feeling-The patients wife gave me a folded bill I tried reasoning but they were so instant when I looked it was $100 and I never felt so awful and horrible in all my life
    I left the money in a drawer in my house for a long time and then I too donated it

    I will never ever allow anybody to give me money again


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