dialysate question

Hello all:

A question. Please explain the dialysate issues surrounding the following situation. If a patient, who is prescribed K3 Ca 2.5 does not get it, due to whatever reason, i.e. staff forgot to add jug after last patient, etc.. not really important why... just want to know what the patient might encounter (physically) if she/he did not receive correct dialysate. The bicarb was the only jug hooked up.

What would the patient expect to have if the K3 Ca 2.5 jug was added about 40 minutes into treatment. Thanks. your input much appreciated.

I'd expect the patient to go crazy listening to the dialysis machine beeping constantly as only having bicarb running would put the machine out of conductivity..

Again imperial your questions don't make sense and really show your ineptness in the field.

I'd expect the patient to go crazy listening to the dialysis machine beeping constantly as only having bicarb running would put the machine out of conductivity..

Again imperial your questions don't make sense and really show your ineptness in the field.

OK, that response was way harsh! Is there a history here that I do not see?

To answer the question of the original post. The machine requires acid and bicard to be in treatment mode. In order to explain bath difference/results, I would like to know what the patient's Rx was and compare it to what was placed on the machine and the patient's pre-treatment lab work.

Keep asking questions imperial...........not all of us will choose to be rude in response.

OK, that response was way harsh! Is there a history here that I do not see?

To answer the question of the original post. The machine requires acid and bicard to be in treatment mode. In order to explain bath difference/results, I would like to know what the patient's Rx was and compare it to what was placed on the machine and the patient's pre-treatment lab work.

Keep asking questions imperial...........not all of us will choose to be rude in response.

I guess you know of all of all Imperial's history then eh..

You of course do know that Imperial is an inspector, correct.. Looking for mistakes in dialysis units??? I would hope that an inspector would know more than this about a discipline they are monitoring.. She has repeatedly asked very leading quesions. How about reading more of her posts.

As far as I know she is not a dialysis nurse never has been , has no desire to become one.. Just find out what we are doing "wrong"

That's the history here that you don't know about.. Remember that old adage "assume"??

And mostly it was a joke... Lighten up yourself.

I'd expect the patient to go crazy listening to the dialysis machine beeping constantly as only having bicarb running would put the machine out of conductivity..

Again imperial your questions don't make sense and really show your ineptness in the field.

My ineptness is because I am NOT a dialysis nurse. I am a patient/family advocate in a variety of settings, volunteer. Therefore, I am learning with the help of this board and the experience that you all offer. Additionally, I have books that I am reading, those that are used for training.

The patient in question did not have any alarms ringing and it was only 'after' the k3 2.5 ca was connected did the conductivity alarm go off showing 'conductivity low'.. this is on a fmc 2008K

My ineptness is because I am NOT a dialysis nurse. I am a patient/family advocate in a variety of settings, volunteer. Therefore, I am learning with the help of this board and the experience that you all offer. Additionally, I have books that I am reading, those that are used for training.

The patient in question did not have any alarms ringing and it was only 'after' the k3 2.5 ca was connected did the conductivity alarm go off showing 'conductivity low'.. this is on a fmc 2008K

As an experienced hemodilaysis RN since 1997 I'm telling you that without acid hooked up, a 2008K Fresenius machine would beep low conductivity.. The acid was probably plugged into the wall where the patient couldn't see it. The unit probably has central acid.. When the acid wand was plugged into the 3k 2.5 Ca++ bath the machine would indeed alarm as the conductivity is different from the standard bath.

Remember a little knowledge can be as dangerous as none at all.

Now I gotta get in the shower to go do some hemodialysis today..

Let me set the record straight. First, I am NOT an inspector/surveyor trying to find out what dialysis units do wrong. I am a 'former' inspector/surveyor, but NOT of dialysis units. Additionally, due to the unfair, inconsistency within the survey process of inspecting and politically incorrect workings, I did not choose to continue a career as a surveyor, longer than a few years. I found that facilities were NOT treated equally, meaning, regulations were not enforced consistently and surveyors had subjectively performed their job which had a direct impact on delivery of patient care. This was in the nursing homes. I had not connection with dialysis until friend became involved, thereby leading me to volunteer, on many levels, to become an active volunteer patient advocate for dialysis patients. Trying to understand various situations, outcomes, etc., I look to those who can share 'true and honest' answers, which can be done from an anonymous standpoint of this board and no one is then put in a position of fear of retaliation for stating something that might be true and detrimental to patient care. The Renal Physicians Assoc collaboratively did a workshop and many healthcare professionals spoke out re the various potential medical errors due to lack of education, over worked staff, time restraints, etc. They were honest etc and this is part of learning the true culture, as they stated of dialysis. I am sorry that some of you are so defensive and feel that I am looking to see what goes wrong in units, I am just posing various situations that have happened, whereby, patient(s) can not obtain accurate answers/responses from staff/physician, etc. I hope this clarifies for those of you who have taken my questions so harshly and interpreted not the way I intended.

The specific situation I have mentioned, occurred as such: Patient was put on machine. Patient noticed that there was only one jug and usually there are two. The blue was connected to jug sitting on front of machine bottom. The red was not connected to anything. There were no alarms and the patient was about 35 minutes into treatment. Prescription is for k3 2.5 ca.

The patient questioned the tech and asked why there was only one jug.. the tech stated,'you are observant'.............then went and checked the run sheet,then obtained a jug and attached to the red connector... it was at that point, a few seconds later, that the 'conductivity low' showed on the machine. the tech told the patient..when he was attaching the jug, :"there was another patient on the machine before you".............

I am hoping that I can continue to dialogue with those of you who are interested in teaching and educating those of us who want to know more and use many resources (as yourselves) to become informed.

My ineptness is because I am NOT a dialysis nurse. I am a patient/family advocate in a variety of settings, volunteer. Therefore, I am learning with the help of this board and the experience that you all offer. Additionally, I have books that I am reading, those that are used for training.

The patient in question did not have any alarms ringing and it was only 'after' the k3 2.5 ca was connected did the conductivity alarm go off showing 'conductivity low'.. this is on a fmc 2008K

Ok, now I understand the situation, but it does not require rudeness on OUR part.

Imperial..It is impossible for the machine (FMC 2008k) to be in dialysis treatment mode and not have an acid bath. The red wand (or acid wand) is the leader of the pack ( so to speak) It has to be out of the holding port of the machine for the machine to rise to the required temperature to be able to obtain conductivity parameters. The red wand controls the machine's functions. In contrast, the blue wand (or bicarb wand) is not required to be connected to bring the machine up to the required temperature or change the screen to dialysis mode. It is required to maintain conductivity which in turn puts the machine in a positon to do dialysis. The blood may be moving through the circuit or tubing, but without conductivity, ultrafiltration can occur, but not dialysis. Diaysis can be compared to washing (removing toxins) and drying (removing fluids) Depending on the patient's condition, either/or and simutaneously both can be accomplished.

As far as the "conductivity low" alarm..It is common and harmless to have that alarm sound when changing jugs. The alarm is saying "hey, you changed the jug"

The machine can only communicate through alarms, but not every alarm on the machine means something is wrong...

Let me set the record straight. First, I am NOT an inspector/surveyor trying to find out what dialysis units do wrong. I am a 'former' inspector/surveyor, but NOT of dialysis units. Additionally, due to the unfair, inconsistency within the survey process of inspecting and politically incorrect workings, I did not choose to continue a career as a surveyor, longer than a few years. I found that facilities were NOT treated equally, meaning, regulations were not enforced consistently and surveyors had subjectively performed their job which had a direct impact on delivery of patient care. This was in the nursing homes. I had not connection with dialysis until friend became involved, thereby leading me to volunteer, on many levels, to become an active volunteer patient advocate for dialysis patients. Trying to understand various situations, outcomes, etc., I look to those who can share 'true and honest' answers, which can be done from an anonymous standpoint of this board and no one is then put in a position of fear of retaliation for stating something that might be true and detrimental to patient care. The Renal Physicians Assoc collaboratively did a workshop and many healthcare professionals spoke out re the various potential medical errors due to lack of education, over worked staff, time restraints, etc. They were honest etc and this is part of learning the true culture, as they stated of dialysis. I am sorry that some of you are so defensive and feel that I am looking to see what goes wrong in units, I am just posing various situations that have happened, whereby, patient(s) can not obtain accurate answers/responses from staff/physician, etc. I hope this clarifies for those of you who have taken my questions so harshly and interpreted not the way I intended.

The specific situation I have mentioned, occurred as such: Patient was put on machine. Patient noticed that there was only one jug and usually there are two. The blue was connected to jug sitting on front of machine bottom. The red was not connected to anything. There were no alarms and the patient was about 35 minutes into treatment. Prescription is for k3 2.5 ca.

The patient questioned the tech and asked why there was only one jug.. the tech stated,'you are observant'.............then went and checked the run sheet,then obtained a jug and attached to the red connector... it was at that point, a few seconds later, that the 'conductivity low' showed on the machine. the tech told the patient..when he was attaching the jug, :"there was another patient on the machine before you".............

I am hoping that I can continue to dialogue with those of you who are interested in teaching and educating those of us who want to know more and use many resources (as yourselves) to become informed.

Personally,,,,,, I believe you are a disgruntled family member and possibly a paid volunteer for the prosecution... And because you aren't able to give an accurate assessment of the situation I refuse to give you ammunition.

I still say the red wand was probably plugged into the wall for central acid..And as you were not an eye witness to the incident I believe you don't have all the facts..

Actually, it's been proven many times that eye witnesses are reliable.

Personally,,,,,, I believe you are a disgruntled family member and possibly a paid volunteer for the prosecution... And because you aren't able to give an accurate assessment of the situation I refuse to give you ammunition.

I still say the red wand was probably plugged into the wall for central acid..And as you were not an eye witness to the incident I believe you don't have all the facts..

Actually, it's been proven many times that eye witnesses are reliable.

I am not and refust to stoop to your level of rudeness. I am NOT a paid anything for the prosecution, or whatever/whoever you state. Furthermore, I don't need to justify to you and do appreciate the responses of truth and experience that are shared. The situation in question was witnessed by two patients... emailed to me....re concern about what could happen. The blue connecter was connected to jug. The red connector was not connected to anything either in the wall or in the jug. It was not until the patient asked 'isn't there suppose to be two jugs' did the staff go and get another jug and connect to the red connector. The jug had written on it 3k 2.5 ca.. the staff stated clearly that there was another patient on themachine prior,, therefore, basically stating that before the next patient was connected to the machine there was not check to ensure accuracy of what needed to be done. I find your defensiveness eye awakening and hope you don't respond with such distaste when your patients ask questions. Again, I do so thank those who share their knowledge. This staff was not rude, nasty etc when the patient asked the question. My simple question was what would the patient experience should there not have been the accurate bath.. thanks.

I am not and refust to stoop to your level of rudeness. I am NOT a paid anything for the prosecution, or whatever/whoever you state. Furthermore, I don't need to justify to you and do appreciate the responses of truth and experience that are shared. The situation in question was witnessed by two patients... emailed to me....re concern about what could happen. The blue connecter was connected to jug. The red connector was not connected to anything either in the wall or in the jug. It was not until the patient asked 'isn't there suppose to be two jugs' did the staff go and get another jug and connect to the red connector. The jug had written on it 3k 2.5 ca.. the staff stated clearly that there was another patient on themachine prior,, therefore, basically stating that before the next patient was connected to the machine there was not check to ensure accuracy of what needed to be done. I find your defensiveness eye awakening and hope you don't respond with such distaste when your patients ask questions. Again, I do so thank those who share their knowledge. This staff was not rude, nasty etc when the patient asked the question. My simple question was what would the patient experience should there not have been the accurate bath.. thanks.

One of the problems I have with you is that you always seem to think the dialysis unit, tech, or nurse is at fault in eveyone of your senarios (sp). And you keep asking the same question over and over to get the answer you want ..Very similar to a prosecution attorney..

I and another poster have told you it's impossible to have the red wand just dangling from the machine not plugged into any thing.. The machine would develop air lock because that is what the wand would be sucking instead of acid.. And still you refuse to believe that.

You had redeemed yourself slightly in my eyes recently but now you've regressed..

Why ask professionals if you aren't gonna take our information..

You asked us why patients weren't compliant as if we weren't teaching them either adequately or at all.. I don't know but I believe many patients end up on dialysis because they weren't compliant with their own care to begin with..

These are adults here.. We can't make them not drink excessively, or take their phosphate binders.

If you don't like the answers you get here maybe it's time to find them in your books..

I just hope you don't condone nurses learning all their skills from a book.

P.S. The previous patient was probably on a standard bath the the acid wand plugged into the wall.. I doubt the staff left the red wand dangling for a full treatment. This is the second or third time you've been told this..OK?????

Also your dig at my nursing care is rude and to think you weren't gonna do any stooping.. I thought I was chatting with a professional here but I guess I was in the wrong..You know nothing of my nursing skills and abilities but I'm finding out about your's quickly.

Personally,,,,,, I believe you are a disgruntled family member and possibly a paid volunteer for the prosecution... And because you aren't able to give an accurate assessment of the situation I refuse to give you ammunition.

I still say the red wand was probably plugged into the wall for central acid..And as you were not an eye witness to the incident I believe you don't have all the facts..

Actually, it's been proven many times that eye witnesses are reliable.

Personally I believe you are paranoid....and I don't think there is anything wrong with question asking...that's how people learn, whether they are healthcare professionals or not...Also, this person states they are a patient advocate...personally, I would hope that we all are..thats our duty. You sound very defensive? Why is that? I say its better to ask questions and get informed answers than not to ask and to just act like you know what you are talking about. I give kudos to imperial for at least coming to trained professionals that can give these such informed responses. Also, I feel that if you feel threatened by this person and don't feel it appropriate for them to ask "leading questions" simply don't answer them...Didn't your mom ever tell you if you have nothing nice to say, don't say anything at all?

What type of machine are your running would let you run it without adding the prescribed K3 Ca 2.5 ?