Code in Dialysis

Specialties Urology

Published

:crying2: I am two weeks into a new Dialysis career. I come from a Critical care background and happen to be ACLS certified. There was a patient that coded at the center today. I was the first one to the patient no pulse and not breathing. I called for O2 and the crash cart which were both brought by a Rt. the Center Director Rn and the charge Rn came at that point. I started directing the code and was asked to leave. Long story short....... the crash cart was never unlocked no 02 to the patient no CPR started no blood sugar obtained. Needless to say I quit but, before I did I wanted to know why the patient wasnt put on a monitor Charge responded by saying ti was broke. I asked why we had a crash cart if nobody knew how to use it, the CD response was that was in case a Dr. was making rounds and wanted to run the code. WTF? Come to find out I was the only person in the building that was ACLS certified and I guess since I had no dialysis experience that would rather have let the lady die to save face. Anyone that has dialysis experience care to explain what the policy concerning a code in their center is? I left out of there distressed that they would not let me do anything for the patient when it was apparent these people didnt have a clue. Thanks!!!!!!!!!!!!
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Specializes in Nephrology, Cardiology, ER, ICU.

How awful! Did the patient die? What kind of standard of care are they providing? Lots of questions...

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Wow, that sounds like a nightmare. That poor patient :crying2: Sounds like the incident needs to be reported to the BON. Sounds like you did the right thing by quitting - I don't blame you for not wanting to work in a place like that :angryfire

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Was there a written (signed by the Dr.) no-code? In our chronic settings we have a crash cart and I always laugh at it. D50 and oxygen tubing for the most part. We do what ever we can before EMS arrives.Standing orders and policy and procedure are followed.

So many questions, was the pt reclined and fluid back, was it a dialyser reaction, no -code pt? Endotoxins drawn on the machine?

I am so sorry you had this experinice. Dialysis pts go out so quickly and a quick assessment is needed. Sounds like the clinic could use you skills.

Document everything while it is fresh in your memory in case it ever comes back and slaps you in the face.

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How awful! Did the patient die? What kind of standard of care are they providing? Lots of questions...

Unfortunetly, I am guilt ridden. I feel like I should have knocked the CD down and insisted on the care I could have given. The patient was not a no code. I dont think the nurse at the clinic would have known one way or the other. This is a Gambro clinic BTW. I intend on finding out the policies because my mom dialysis at one of the clinics. Nurses like that scare the heck out of me, Hey if I dont know it I just say I dont. Thanks for listening everyone. I am still crying and I cant sleep.

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Specializes in Hemodialysis, Home Health.

Wow... I am so sorry, Paris. :o

I do know that at our facility, we would give blood back immediately, saline, Trendelenburg, and do CPR while waiting on an ambulance. We do not intubate. We have a crash cart as well, but again, unless the medical director is actually there, we do not use any cardiac drugs, so it's pretty much useless. But our hospital is right up the street, and the ambulance is here in a heartbeat.

So we provide basic life support, but that's it. Every facility has it's own code policies, you might want to check these out before working at one, and certainly that of your mother's.

(((HUGS))) to you.

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Wow... I am so sorry, Paris. :o

I do know that at our facility, we would give blood back immediately, saline, Trendelenburg, and do CPR while waiting on an ambulance. We do not intubate. We have a crash cart as well, but again, unless the medical director is actually there, we do not use any cardiac drugs, so it's pretty much useless.

We do the same at our facility. I can't believe they just let the pt die! Holy cow! That just isn't right.

We had a "near code" at our facility a couple months ago. Still had a pulse, was barely breathing. We threw her back into Trendelenburg, returned her blood and gave her saline, and we used an ambu-bag to help her breathe...and of course called 911. (There's a fire department with paramedics right across the street...it doesn't take but a couple minutes for them to get there).

All of our pts are watched closely while on HD. We normally set the BP on the machines to go off more often on the pts that are either new or known to drop. We've got a room full of O2 as well, so that's never a problem to get to a pt.

Also, if a pt is under no code status or has an advanced directive, that is suspended while at the dialysis center. (The pts are informed of this when they first start tx at our facility.) If a pt crashes, we do everything we can to revive them/keep them alive/etc. If the pt is still unresponsive by the time the medics get the pt to the hospital, it's at the discretion of the hospital whether or not to proceed with the code.

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Specializes in ICU, CM, Geriatrics, Management.

Paris -- Be glad you're out of there.

Best to ya!

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sounds like some morons there.

I went to chronic dialysis(in acutes now thank god) after being and icu nurse for several years. when things like you describe happen, it can be a blessing and a curse to have acute experience. Gambros policies are the same as the previous poster said. You should minimally have initiated cpr, fluid/blood return, and o2. Cardiac drugs are not supposed to be given in chronic setting unless MD is there.. 911 is supposed to be called. I had a patient fall out in the lobby. He never went apulsatile but his hr was 35 and bp was low. I had a tech put a cannula in him and gave atropine even tho I wasnt supposed to. Our director didnt give me a hard time about it. FYI atropine does crap for bradycardia when its related to hyperkalemia :chuckle

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Specializes in Medical.

Paris, just wanted to add my commiserations. I'm sure the experience would've been stressful enough, but having to worry about your mother being in that situation... I really feel for you.

Our dialysis unit is relatively used to codes, as it's located in a tertiary, trauma-level hospital, but I know there have been issues at some of the satellite units - not that codes haven't been run so much as that the staff haven't had the (recent) experience needed to know precisely what to do. There's some talk of staff rotating occasionally to the more acute centres, but I can see a lot of resistance to that.

All the things you mentioned, particularly checking a blood sugar, are things that you just don't remember if you haven' been involved in a code for a while - it wouldn't even surprise me to learn that some of the nurses have never been in that situation. It's a real shame that the staff at your former workplace, especially the senior staff, weren't able to let go of their own egos to take advantage of your acute experience.

I agree with other posters - document what happened and take it further.

Good luck :)

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:uhoh21: It is beyond me how anyone works dialysis. I knew absolutely nothing about it and went and interviewed at a dialysis clinic a week ago.

(It's located next to a fire station ~ convenient?)

Anyway, I shadowed one of the nurses for over an hour.

I came out of there vowing I would never work dialysis.

I'm sorry, no disrespect intended; but hooking somebody up to a machine is not my idea of nursing.

Yes, they deserve the care and it needs to be done. I'm just not going to be the one to do it.

I would go insane working dialysis.

The Mgr. told me it was very stressful ~ I believe her.

Dialysis nurses, kudos to you.....

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Well, first of all your fonts are very big and annoying :o

Second of all, I do acute dialysis which is much different from chronic. It is a cakewalk. Even if I'm doing a very unstable ICU patient, they are the only one I have to worry about for 3-4 hours. I can read books, study, watch tv, or surf the net on the hospital's wireless internet while the patient dialyzes(if they are stable) I've done my time with "real nursing" running around like a chicken with my head cutoff. Oh did I mention I'll make 80-90k this year barely working any overtime? :rotfl: :rotfl:

dialysis aint so bad :rolleyes:

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