Am I the only one who thinks this is an accident waiting to happen?

[Alex Egan, LPN, EMT-B]

Ok. So I just started in chronic hemo. I was just wondering if anyone else finds it strange in the era where we are hyper aware of look alike sound alike drugs, all the acids are the same color code?

My clinic uses 2-2.5, 3-2, and 3-2.5. They all print out in the same small print on the flow sheets and are marked with red stickers on the wall ports, all clearly marked, but man those numbers are all close.

I also managed to mess up a batch of acid because a box of 3k-2.5 snuck in with a 2k-2.5 which was really inconvenient, and got me thinking about this.

I dont know the fix, or if it's a problem really. I guess after a while you just get used to the number soup and it becomes easier.

[Chisca, RN]

The patient's serum potassium plus the potassium of the bath you are using divided by 2 gives you a rough guess at what the potassium level is at the end of the treatment. Let's use a serum K of 4 as an example. On the 2 k bath 4+2 /2 =3. Use a 3k bath and 3+4/ 2 = 3.5. Even if you use a 4K bath 4+4/2 =4. The calcium level in the bath is physiological and unless you have something wrong with the parathyroids I don't see any benefit in higher ca levels in baths. I'm not saying you shouldn't pay attention but on bath choice alone it's pretty hard to kill someone based on dialysis bath you use. Now a 1K bath scares me.

[StarBrownRN]

Be diligent, but don't be scared. A patient prescribed a 3k and ends up on a 2k will most likely not go into cardiac arrest after one 3.5hr treatment.

When I was in chronic, we switched to using only the most common concentration among our patients from the wall. All else was made in individual jugs. There were times when patients would be prescribed a concentration we didn't have; we'd call the doctor and he'd change it to something we did have. (Which makes you wonder...)

It's still very easy to miss the dialysate bath on the flowsheet when you are rushing to set-up. As Chisca mentioned, the only time it is very dangerous is if the patient has a very high K. We wouldn't even treat those patients because we had no cardiac monitoring capabilities; so, we sent them to acutes.

I guess one way to be sure that everyone is on the right bath is to do very thorough Nurse TX verifications.

[GeauxNursing]

Davita in our area is now using a Mix Master, a tech who travels and mixes acid. There has been way too much waste over the past couple years from PCTs mixing acid while trying to run a bay. It is just too much for them to do, unless they are required to come early or stay late and focus only on this task. Which wasn't feasible with the budget. Mistakes are made, acid is wasted. So they now have just one guy do it. If the Bio med is not in charge of mixing acid in a clinic, the Mix Master comes in.

[nurseontheway]

The mix master would be a good name for a DJ!