Ask A Hemodialysis Nurse (Questions about how to become one of us)

[madwife2002]

Hi I am a HD nurse with experience in PD and knowledge of HHD plus Transplant

I have over 14 years Renal experience, 4 years OB/GYN and 9 years Tele

In this forum we often see questions asked about dialysis nursing and what it is like.

I would love to answer any questions about my profession and if I don't know the answer I will find out!

In dialysis nursing we have a statement that we like to share

"you either love it, or you Hate it-there is no in-between"

[jdub6]

Thank you everyone! This is something you hear a lot about but never get to experience at all unless you specialize (where I've worked we weren't even allowed to change a wet or half-off dressing on a dialysis cath even though the dressing sure looked the same as any other central line.)

[AcuteHD]

...where I've worked we weren't even allowed to change a wet or half-off dressing on a dialysis cath even though the dressing sure looked the same as any other central line.

Exactly. The. Same.

I don't get that either, but it must be a fairly universal policy.

[Chisca, RN]

(where I've worked we weren't even allowed to change a wet or half-off dressing on a dialysis cath even though the dressing sure looked the same as any other central line.)

If you page me at 2am to change a dressing I'll talk you through it. It is EXACTLY the same as any other central line dressing.

[GRounded1]

Thank you so very much for being willing to answer any Dialysis related question. I am interested in PD nursing and just wondered what a typical day is like for a PD nurse and where will the position lead me. I eventually wanna be a manager?

[AcuteHD]

I only have peripherial knowledge about PD, but it seems like a lot of record keeping and training. I think they also train the home HD patients also. Doesn't seem like a bad gig to me. As for management, I see a lot of turnover in the clinic level management office, so you can take that as good or bad.

[Loveyourkidneys]

Texas regulations: charge nurse can have 12 patients. Not sure where 18 is allowed?? That is too much

[madwife2002, BSN, RN]

Thank you so very much for being willing to answer any Dialysis related question. I am interested in PD nursing and just wondered what a typical day is like for a PD nurse and where will the position lead me. I eventually wanna be a manager?

Do you have any Renal experience?

A lot of dialysis centers are cross training their home nurses these days, the RN's will do the PD and HHD training.

It takes about 3 months to train/orientate a RN to PD and the same for HHD.

You can be expected to train 2 PD patients a day-their training and it should be individualized can take 8-10 days. Currently if you use baxter products patients are experiencing a delay in going to IPD using the NXstage peritoneal dialysis machine, so patients may go home on CAPD.

They will need to return to the clinic to retrain onto Nxstage.

You will be expected to be once for home patients, should there be an emergency overnight you would troubleshoot issues and problems via the phone.

Monthly labs and follow up

Nephrologists will see puts monthly, normally at the home therapy center.

Home visits for new patients and home visits to assess conditions post peritonitis

A lot of IDT work

Education for family and patients

[carolyn38668]

I've been a nurse 5 years, mostly as an OR Circulator, 3 yrs L&D mixed in because I've done PRN in the past. I've been thinking about trying dialysis for a while and have applied for a couple positions with Fresenius. These threads are helpful. What should I expect daily with managing patient load, documention etc. Type of hours/schedule. Any insight would be appreciated. My husband is concernec about the risk of blood exposure, but I can't imagine it's any worse than the OR or L&D.

[GenSurgRNFA, BSN]

I am starting on a dialysis unit in a week, I graduated from school in may and Im kind of nervous/scared that when im done with orientation i still wont know what im doing. Or how long my orientation will be. I know its just new grad jitters but I think about screwing up all the time:(

[supfiq]

Hi I've some questions to ask regarding dialysis. I'm currently tasked to improvise fistula needles and I would like to clarify my doubts on the following:

1) Once the needle is inserted into the artery, is it left inside the arm throughout the entire dialysis session? And if so, won't it cause harm towards the patient if they get restless?

2) Would a blood flashback chamber be helpful (similar to that of an IV catheter) to assist nurses in successfully entering the artery?

[jlautier]

I want to elaborate on the HD perm catheters--

sure looked the same as any other central line.)

You are correct, it is a CVC like any other CVC. heparin dwells at 1,000units per ml, so don't get freaked out. The reason why nephro docs and HD rn's alike tweek about using a CVC that was inserted into a patient for HD is because we want to limit those who access it to ensure that CVC is patent, not infected, and also persevered for hemodialysis only.

Key here is without that CVC the patient would not be able to get dialysis, they would need another line placed if that one gets infected or isn't properly cared for.

That is why nephro people tweek if you say.. "Can't i just draw that CBC off there CVC, have you tried getting blood out of this patients veins, my god, its like so impossible" chances are the person has a CVC on chronic HD because they have serious PVD and AVF or AVG creation is impossible.

To recap, those CVC's are to be left alone. Caveat--if you see a soiled dressing as indicated above, contact the nephro on-call, say, "The patients HD CVC dressing is soil and falling off, I wanted to check with you because we don't ever touch HD accesses, but I want to change it because it looks gross AF"

^^every doc will say, change it, thanks for calling. evening if its the night on-call person. and if they get upset, you say.. "i don't want them to get septic doc.. jeez."

[jlautier]

1: Needles remain in till the treatment is done; patients who get restless and bend their arm hand a chance at infiltrating. What happens is similar to a peripheral line except the instead of a rate of 100cc/hr; its 500cc/min; and a massive, painful, hematoma forms and the fistula needs to de-accessed and rested before the next treatment.

2.When patients are cannulated correctly, the needles flash back; if an HD RN is in doubt of placement, a 10cc syringe can be connected and the line flushed. IF met with resistance; the needle needs to be readjusted.

hope it helps!